Systemic treatment of advanced non-small cell lung cancer

Lung cancer, a highly lethal malignancy, is the leading cause of cancer-related mortality in the US, accounting for 28% of all deaths related to cancer. Non-small cell lung cancer comprises 80-85% of lung cancer diagnoses and includes the histologies of adenocarcinoma and its subtype bronchoalveolar carcinoma, squamous cell carcinoma and large cell carcinoma. This article reviews the use of cytotoxic chemotherapies and other systemic treatments for patients with advanced (metastatic and/or recurrent) non-small cell lung cancer. Despite great efforts, only minor gains have been made over the past decade in the treatment of advanced non-small cell lung cancer for patients with a good performance status in terms of prolonging survival and improving quality of life. Currently, the standard of treatment is a platinum-based doublet, with the second agent being selected contingent upon the comorbidities of the patient and the toxicity profile of the drug. The focus of clinical research is centered on the application of the use of targeted, molecularly directed therapies, likely used in combination with either cytotoxics and/or other novel targeted agents, in an attempt to improve the therapeutic ratio of systemic treatments for this large population.