NEW CHEMOTHERAPEUTIC-AGENTS PROLONG SURVIVAL AND IMPROVE QUALITY-OF-LIFE IN NONSMALL CELL LUNG-CANCER - A REVIEW OF THE LITERATURE AND FUTURE-DIRECTIONS

In past years, there has been considerable pessimism over the role of chemotherapy in non-small cell lung cancers, The pessimism was largely derived from the fact that alkylating agent-based therapies shortened survival and produced severe side effects. This was especially import ant because the vast majority of patients (similar to 85%) develop met astatic disease during their course. Randomized trials from the 1980s showed that cisplatin-based chemotherapy improved patient survival, im proved quality of life as assessed by the patients, and relieved sympt oms in the majority of symptomatic patients. When chemotherapy was adm inistered on an outpatient basis, it actually lowered the total patien t care costs for advanced stage patients. In the 1990s, five new agent s, including two taxanes (paclitaxel, docetaxel), gemcitabine, navelbi ne, and irinotecan, were shown to produce higher response rates and lo nger survival in Phase II trials compared to cisplatin or carboplatin, In randomized trials, combinations of paclitaxel, gemcitabine, and vi norelbine with cisplatin improved the survival of advanced stage patie nts compared to cisplatin alone or in combination with etoposide, The toxicity profile of the new agents is also favorable compared to cispl atin-based therapy, Preliminary results in earlier stages are also enc ouraging, Thus, currently available chemotherapy given to non-small ce ll lung cancer patients with good performance status can improve survi val to a similar extent as other solid tumors, such as small cell lung cancer and breast cancer.