Autologous bone marrow transplantation for the treatment of lung cancer

Non-small cell lung cancer is extremely difficult to treat in all stages, and small cell lung cancer patients are cured rarely despite initial responsiveness to conventional chemoradiation therapy, even when diagnosed in limited stage. Intensive cytotoxic therapy has been explored in both small cell and non-small cell lung cancer patients, since a number of agents showed an increased response when given in high dose followed by autologous bone marrow reinfusion. The antitumor responses of single-agent high-dose trials were short-lived, but set the stage for combination chemotherapy trials given in earlier disease stages, ie, as consolidation or intensification therapy in lung cancer. In 11 published trials, 204 small cell lung cancer patients have undergone autologous bone marrow transplants. Although the transplant-related mortality rate in these studies was 7%, the long-term disease-free survival rate was 14% in a heterogeneous group of patients receiving a variety of regimens. The data gleaned from these studies suggested that a subpopulation of lung cancer patients may benefit from the use of this approach if it were to be administered at a time when the tumor burden was low. Because of the great cost of this procedure, however, third-party payers seldom provide financial coverage for these procedures. Hence, while great strides have been made in the therapy of other solid tumors, such as breast, testicular, and ovarian cancers, the role of autologous stem cell transplantation in small cell and non-small cell lung cancer remains yet to be defined.