[Can improvement in therapy decrease the rate of death due to lung cancer?]

The incidence of lung cancer is increasing, and therapy for patients with this disease is not satisfactory. Surgery is done for patients with clinical (c)-stage I, II, and resectable stage IIIA non-small cell lung cancer (NSCLC). Chemotherapy, alone or in combination with radiotherapy, is given to patients with unresectable stage IV and stage III NSCLC, respectively. Chemotherapy is an important therapeutic modality for patients with small cell lung cancer (SCLC). CDDP + VP-16 (PVP) and CPA + ADM + VCR (CAV) alternating PVP regimens are standard treatment for patients with SCLC. Chemotherapy and radiotherapy are given to patients with limited disease. To develop more effective treatments, we are investigating (1) the schedule and timing of radiotherapy, (2) combination chemotherapy including new drugs, (3) dose-intensive chemotherapy, and (4) new strategies such as gene therapy. Radiotherapy is commonly used sequentially and the standard fractionation is 2 Gy/fr/day. We are studying other timings, such as concurrent and alternating, and other schedules, such as hyperfractionation and accelerated hyperfractionation. Promising new drugs include paciltaxel, docetaxel, vinorelbine, and CPT-11. These are now used in combination with platinum. To evaluate dose-intensive chemotherapy for SCLC, we are conducting a phase III study comparing CODG + G-CSF with CAV/PVP.