Management (chemotherapy/best supportive care) of advanced-stage non-small cell lung cancer

Non-small cell lung cancer (NSCLC) represents almost three quarters of all cases of lung cancer. Most NSCLC patients present with either locally advanced inoperable disease, stage IV metastatic disease, or comorbid medical conditions that make them unsuitable for curative resection. Among NSCLC patients in the United States, overall 5-year survival rates range from 10% to 15%. Systemic chemotherapy has had minimal impact on prolonging survival or improving quality of life. Combination chemotherapy regimens containing cisplatin usually produce the best overall response rates. Combination chemotherapy in one study also has been shown to be more efficacious and less expensive than best supportive care. Newer cytotoxic agents, including vinorelbine, gemcitabine, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), docetaxel, and the camptothecins, have shown promise in the treatment of NSCLC. In combination with other effective agents (eg, cisplatin), response rates approaching 50% have been observed. A greater understanding of the biologic properties of lung cancer may help facilitate early detection and chemoprevention in patients at risk.