This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Evans, T. L. Articles by Lynch, T. J. Search for Related Content PubMed PubMed Citation Articles by Evans, T. L. Articles by Lynch, T. J., Jr.

Lung Cancer

Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA

Correspondence: Thomas J. Lynch, Jr., M.D., Massachusetts General Hospital Cancer Center, 100 Blossom Street, Room 201 Cox, Boston, Massachusetts 02114, USA. Telephone: 617-724-1136; Fax: 617-724-1137; e-mail: tlynch{at}partners.org

Is any one combination therapy for metastatic non-small cell lung cancer (NSCLC) superior to other regimens for metastatic NSCLC? The answer is "probably no." More than 4,000 patients with advanced NSCLC participated in randomized trials presented at the 37th Annual Meeting of the American Society of Clinical Oncology. TAX326 was the only study in which the investigational arm (cisplatin/docetaxel) showed a statistically significant difference in survival compared with the reference standard (cisplatin/vinorelbine). We did learn, however, that what we administer may make some difference: cisplatin might be superior to carboplatin, and patients treated with nonplatinum chemotherapy regimens have a trend toward poorer survival than those who receive platinum doublets. Although there is still no clear best regimen for advanced NSCLC, we may now know how much chemotherapy to give: a randomized study presented found that four cycles produces as much survival benefit as treating until progression. The most significant abstracts presented at this year's lung cancer session involved the use of novel agents with unique mechanisms of action. The median survival in the large, randomized trials of chemotherapy in advanced NSCLC remains a bleak 9 months. ISIS 3521, an antisense oligonucleotide that targets protein kinase C, was found to produce a near doubling of survival when combined with carboplatin and paclitaxel. OSI-774, an epidermal growth factor receptor tyrosine kinase inhibitor, was shown to have impressive single agent activity in the second-line treatment of lung cancer. The future of lung cancer therapy will involve combining these novel agents with active chemotherapy regimens in an effort to improve outcome.

While we appear to have reached a plateau in what we can accomplish with various combinations of cytotoxic chemotherapy in metastatic NSCLC, in locally-advanced disease new chemotherapy combinations can achieve remarkable results when combined with radiation therapy. The Southwest Oncology Group presented unprecedented phase II data on the use of cisplatin and etoposide with concurrent radiation therapy followed by consolidation docetaxel in patients with stage IIIB NSCLC.

Key Words. Non-small cell lung cancer • Metastatic disease • Treatment • Stage IIIB NSCLC

This article has been cited by other articles:

				M. Berhoune, E. Banu, F. Scotte, P. Prognon, S. Oudard, and B. Bonan Therapeutic Strategy for Treatment of Metastatic Non-Small Cell Lung Cancer Ann. Pharmacother., November 1, 2008; 42(11): 1640 - 1652. [Abstract] [Full Text] [PDF]

				M. G. Kris How Today's Developments in the Treatment of Non-Small Cell Lung Cancer Will Change Tomorrow's Standards of Care Oncologist, October 1, 2005; 10(suppl_2): 23 - 29. [Abstract] [Full Text] [PDF]

				M. Ferrone and S. E Motl Trastuzumab for the Treatment of Non-Small-Cell Lung Cancer Ann. Pharmacother., December 1, 2003; 37(12): 1904 - 1908. [Abstract] [Full Text] [PDF]

				B.T. Hennessy, E.O. Hanrahan, and O.S. Breathnach Chemotherapy Options for the Elderly Patient with Advanced Non-Small Cell Lung Cancer Oncologist, June 1, 2003; 8(3): 270 - 277. [Abstract] [Full Text] [PDF]