[Chemotherapy of cancer of the lung]

Based on the present experience, it is suggested that CDDP plus VP16 is associated with a reproducible 30-40% objective response rate in NSCLC (Non-Small Cell Lung Cancer). Although symptomatic relief is not rare in responding patients, serious morbidity from chemotherapy may also occur. Overall, the duration of the response is not very long (the median duration is approximately 6-8 months) and only modestly influences the survival of responding patients (the median survival in non responders is usually 4-5 months). In addition, due to such factors as the relatively low response and the serious morbidity from treatment, the overall survival and quality of life for these patients has not substantially improved. As for as SCLC (Small Cell Lung Cancer) is concerned, the impact of chemotherapy despite the introduction of VP16, carboplatin and ifosfamide, has remained essentially unchanged for more than ten years. Maintenance chemotherapy, alternating non cross resistant combinations and intensive treatments, with presently available drugs, have failed to improve the prognosis of patients with SCLC. Combined radio chemotherapy also fails in this regard. Truly limited disease should definitely be treated with chemotherapy followed by surgery, as the potential for prolonged survival looks realistic. Therapy of more extensive disease still remains a challenge; despite the failure of early and late intensification programs, more aggressive initial multi-drug therapy represents an alternative approach.