Evolution of non-small cell lung cancer chemotherapy (Review)

Non-small cell lung cancer (NSCLC) is a common malignancy which has been increasing in incidence over the last decades. In the past, these tumors were considered quite resistant to chemotherapy and until the development of cisplatin 30 years ago, the use of cytotoxic drugs was considered palliative. Cisplatin (CDDP) proved to be an active agent and when combined with other cytotoxic drugs, effectiveness in NSCLC increased. Many trials have taken place during the last 30 years with cisplatin combinations. Despite the effectiveness of cisplatin, the renal toxicity and neurotoxicity that are produced obliged researchers and clinicians to create other combinations without CDDP. Carboplatin, an analogue of CDDP and then taxanes, gemcitabine and vinorelbine, a Vinca alkaloid, that proved to be effective in NSCLC, led to substitute combinations for CDDP. In the present article we review the literature on NSCLC chemotherapy in order to visualize the effectiveness of older drug combinations vs. the newer ones. It seems that combinations with or without cisplatin are of similar effectiveness with respect to response rate and median and overall survival but the toxicity is different with a prevalence of myelotoxicity.