Combined-modality therapy for inoperable non-small-cell lung cancer using gemcitabine

Combined-modality therapy with chemotherapy and radiation appears to be the most efficacious therapeutic modality for patients with locally advanced non-small-cell lung cancer. Most of the trials exploring this approach have utilized older agents such as cisplatin, vinblastine, and etoposide. Recent data suggest that gemcitabine may be superior to these agents therapeutically, with the ability to produce similar or improved outcomes and a milder overall toxicity profile. Moreover, gemcitabine is able to sensitize tumor cells to radiation-induced apoptosis as well as lead to induction of cells in the radioresistant S phase of the cell cycle. These results have suggested that gemcitabine should be tested in concurrent chemoradiotherapy regimens. Significant toxicities seen in the initial trials have led to a number of trials modifying the regimen so that efficacy might be maintained without adverse effects. These modifications have included lowered gemcitabine doses and reduced radiation field sizes. The results of these newer studies suggest that this approach can be highly efficacious, with 1-year survival rates > 50% and response rates as high as 88%.