Lung cancer

In SCLC, combination chemotherapy including agents such as etoposide, teniposide, cisplatin, carboplatin, doxorubicin, vincristine and cyclophosphamide continues to be the backbone of therapy. Epipodophyllotoxin derivatives, together with cisplatin or carboplatin are being increasingly used as part of the initial therapy. Complete plus partial responses to combination chemotherapy occur in 80-90% of all patients with a median duration of 9-11 months. Median survival in these studies is at present 11-16 months, depending on the initial tumour stage. At this point, 5-year survival is around 5% and includes a small fraction of patients (1%) initially presenting with extensive disease. The optimum duration of treatment is still uncertain, but the tendency is to shorten the duration of treatment to 6-9 months. The results of intensifying the treatment with the use of hematopoietic growth factors have hitherto been disappointing. The results of several phase II studies stress the importance of dose scheduling of etoposide in SCLC, with continuous treatment of 5 days' duration or more being superior. The therapeutic results for squamous cell carcinoma, adenocarcinoma, large cell carcinoma and mesothelioma are essentially unchanged. The treatment of patients with these types of lung cancer should continue to be considered experimental, since no standard chemotherapy has as yet been developed, neither when given as single modality nor in combination with surgery or radiotherapy.