Locally advanced NSCLC: current state of the art, treatment and future directions

Combined chemoradiotherapy is the current treatment standard for patients with locally advanced non-small cell lung cancer. Recent trials have shown increased benefit with concurrent versus sequential administration. Specifically, recently reported results of a large, randomized phase II trial support this conclusion and provide evidence that the addition of consolidation chemotherapy after concurrent chemoradiotherapy may further improve outcome. Concurrent chemoradiotherapy offers substantially improved 2-year survival among patients with locally advanced disease over the previous standards of radiotherapy alone and sequential administration of chemotherapy and radiotherapy. To further improve survival, investigators are evaluating the addition of molecularly targeted therapy to chemoradiotherapy in this treatment setting. The current focus of research is the addition of epidermal growth factor receptor inhibitors (tyrosine kinase inhibitors or monoclonal antibodies), which appear to act synergistically with radiotherapy. Current trials are combining these inhibitors with chemoradiotherapy in a variety of treatment strategies, including induction, primary, consolidation, and maintenance therapy. This article reviews the development of the current treatment standard and current research into new treatments with epidermal growth factor receptor inhibitors.