Chemotherapy of lung cancer

The potential for substantial improvement in the outcome of patients with carcinoma of the lung seem most likely to develop in the field of chemotherapy. In the past decade, striking advances in the management of small cell carcinoma have yielded response rates and longer survival. While the greatest improvement can be predicted for patients whose disease is limited in extent, combination chemotherapy and combined modality therapy generally are effective in causing tumor regression for the majority of patients. About 20 percent of patients with disease limited to the thorax and lymph nodes will survive two years. In non-small cell tumors, response rates are improved with intensive drug combinations, although the majority of cases are unresponsive to present regimens. Careful staging and evaluation of patients indicates that patients with good performance status and limited extent of disease appear to obtain the most benefit from intensive treatment. The considerable morbidity of some treatments often influences the choice for or against chemotherapy in patients with non-small cell carcinomas. For the future, problems of particular interest will be in investigation of factors-biologic, pharmacokinetic, immunologic-that are related to the failure to cure small cell carcinoma, the most therapeutically responsive pulmonary tumor. Additionally, in the non-small cell tumors, more effective therapies as well as clarification of the basis for relative resistance to cytotoxic agents are areas for intensive investigation.