Chemotherapy in the management of patients with inoperable non-small cell lung cancer

Lung cancer remains a major epidemic problem worldwide. The majority of cases are associated with cigarette smoking and the number of people who smoke continues to increase. As a result, the number of lung cancer cases and deaths is expected to increase proportionately over the next decade. The majority of patients who develop lung cancer die of this disease. Non-small cell lung cancer (NSCLC) accounts for 75% of all new cases. The only hope for significant survival depends on surgical resection. At the time of initial presentation, unfortunately, the vast majority of patients are inoperable, either because of advanced disease or because of the presence of comorbid medical conditions such as coronary artery disease. For these reasons, the overall survival rates for patients with NSCLC range from 10% to 15%, figures that have not improved substantially for 20 years. The role of systemic chemotherapy in this population remains debatable for many physicians. Nevertheless, recent studies clearly demonstrate that effective systemic chemotherapy in selected patients can improve survival, quality of life, and performance status. Recently, newer cytotoxic agents, such as vinorelbine, gemcitabine, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), docetaxel, and the camptothecins, have demonstrated their activity in treating patients with NSCLC. When combined with other effective agents, response rates exceeding 50% have been achieved, with median survivals of more than 1 year. The use of these newer agents in combination with well-established agents holds promise for the role of systemic chemotherapy in the future management of patients with early or late-stage NSCLC.