Treatment of advanced non-small cell lung cancer

Lung cancer is now the leading cause of cancer-related mortality for men and women in North America. Non-small cell lung cancer (NSCLC) accounts for more than three quarters of all primary lung tumors. Chemotherapy, however, has had little impact on the survival of patients with NSCLC. Agents like cisplatin, ifosfamide, and mitomycin, used singly and as part of combination regimens, have shown some activity in NSCLC, but have had only a modest effect on the long-term survival of patients with locally advanced and disseminated disease. Combination chemotherapy and promising new agents like gemcitabine, vinorelbine, paclitaxel, and docetaxel warrant further study, as does the use of chemotherapy in novel combined-modality regimens. For patients with locally advanced disease (stages IIIA and IIIB), the goal of chemotherapy must be to increase cure rates, whereas for patients with advanced disease (stage IV), palliation of symptoms and prolongation of survival with an improvement in the quality of life represent reasonable treatment goals.