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New chemotherapeutic agents for non-small cell lung cancer
V A Miller1, J R Rigas, S C Grant
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Abstract:
The identification of new chemotherapeutic agents for the treatment of non-small cell lung cancer should proceed in a structured, logical fashion. Agents should be evaluated on the basis of multiple objective and subjective end points. A 15% or greater major objective response rate, demonstrated in multiple single-agent phase II trials, is considered the lower limit for an agent to be deemed clinically active in this disease. A number of drugs previously have been identified in this category, including cisplatin, ifosfamide, mitomycin, paclitaxel, and the vinca alkaloids vinblastine and vindesine. Most of these conventional agents have been explored alone, in a variety of doses and schedules, and in combination. In the last several years clinical development has produced new agents, including chloroquinoxaline sulfonamide, docetaxel, edatrexate, gemcitabine, irinotecan, topotecan, and vinorelbine, which hold promise for more successful treatment of this lethal disease.
Insights
Identifying effective new chemotherapeutic agents for non-small cell lung cancer requires structured evaluation. A major objective response rate of 15% in phase II trials indicates clinical activity for novel lung cancer treatments.
Area of Science:
- Oncology
- Pharmacology
Background:
- Non-small cell lung cancer (NSCLC) treatment requires continuous development of novel chemotherapeutic agents.
- Established agents like cisplatin and paclitaxel have been foundational in NSCLC therapy.
- There is an ongoing need for agents with improved efficacy and safety profiles.
Purpose of the Study:
- To outline a structured approach for identifying and evaluating new chemotherapeutic agents for NSCLC.
- To define objective criteria for determining clinical activity of novel agents in NSCLC.
- To highlight promising new agents emerging in NSCLC clinical development.
Main Methods:
- Evaluation based on multiple objective and subjective endpoints.
- Utilizing single-agent phase II trials to assess efficacy.
- Establishing a minimum major objective response rate of 15% for clinical activity.
Main Results:
- A 15% major objective response rate in phase II trials is proposed as a benchmark for clinical activity.
- Several conventional agents (e.g., cisplatin, paclitaxel) meet this criterion.
- Newer agents like gemcitabine, irinotecan, and vinorelbine show promise for improved NSCLC treatment.
Conclusions:
- A structured, evidence-based approach is crucial for advancing NSCLC chemotherapy.
- The 15% response rate threshold provides a standardized measure for agent evaluation.
- Emerging chemotherapeutic agents offer potential for more effective NSCLC treatment strategies.