The management of advanced non-small cell lung cancer (NSCLC) is rapidly ev
olving. Advances in combined chemo-radiation therapy have led to improvemen
ts in patient survival which are statistically significant, but most patien
ts still succumb to their disease. New chemotherapeutic agents, such as tax
anes (paclitaxel, docetaxel), topoisomerase inhibitors (topotecan, irinotec
an), and novel analogs (gemcitabine, vinorelbine), may offer the promise of
improved outcome, but have not yet been tested in phase III trials. Molecu
lar therapeutics, such as gene therapy, drugs that target specific oncogene
activation (such as Ki-ras inactivation by farnesyl transferase inhibitors
), and hypoxic cell toxins (such as tirapazamine), are in clinical trials.
The optimum use of these agents awaits more rapid and widespread molecular
diagnostics. Finally, technological advances in radiotherapy will allow hig
her tumor doses, while minimizing doses to dose-limiting normal structures,
such as the esophagus, normal lung and heart. We describe a move towards m
olecular strategies, both for therapy and diagnostics, that may result in m
ore effective treatment. While the outcome for patients with advanced non-s
mall cell lung carcinoma is still poor, new agents are being developed rapi
dly and offer the hope of improved survival. (C) 2000 Elsevier Science Irel
and Ltd. All rights reserved.