[The status of chemotherapy in non-small-cell bronchial carcinoma]

In non-small-cell lung cancer the effect of chemotherapy has in the past been considered to be strictly palliative and of limited duration. Because of these limitations, cytostatic therapy has been applied more sparingly in non-small cell lung cancer than in small-cell lung cancer. It must be emphasized, however, that the relatively low remission rates of 30 to 40% cited in the medical journals over the past decades stem predominantly from patients who have reached the disseminated tumor stage IV. More recent results in clinical trials have indicated that the prognosis of stage III non-small cell lung cancer can be improved by multi-modality treatment regimens, whereby the early application of chemotherapy would appear to play a decisive role. By combining chemotherapy with subsequent radiotherapy the incidence of distant metastases can be reduced, despite the fact that the appearance of local relapses could not up until now be prevented by such treatment.

New hope has arisen following the publication of results from studies in which polychemotherapy (with or without radiotherapy) was applied pre-operatively. It would appear possible to lengthen the survival time of patients with locally advanced cases of primarily inoperable tumors when, as study results indicate, chemotherapy induces a remission which allows for subsequent tumor surgery. These positive results which, up until now, have been derived solely from uncontrolled trials, must of course be substantiated by controlled phase III studies. In addition and parallel to the application of chemotherapy within a multi-modality treatment concept, improved results should also be sought by the usage of new drugs.

We are hopeful that clinical trials with the topoisomerase I-inhibitors Topotecan and CPT 11 as well as the taxanes taxol, Taxotere and Gemcitabine, an analog of the cytosine-arabinoside, will prove successful.