State-of-the art treatment of locally advanced and metastatic non-small cell lung cancer

Despite the poor mortality figures from lung cancer, advances have been observed in the treatment of advanced (stages IIIB and IV) non-small cell lung cancer (NSCLC). In the first instance, such advances have been achieved thanks to chemotherapy (CT) consisting of platinum-based compounds (results demonstrated in several phase III studies) and then thanks to newer cytotoxic agents such as gemcitabine. Used as monotherapy, gemcitabine provides a marked benefit compared to the standard treatment consisting of etoposide/cisplatin (EC) (21% objective response, 39% survival at 1 year). A good efficacy profile of this agent in combination with platinum analogs was also observed in randomized phase III studies, confirming the significant higher survival obtained with the gemcitabine/cisplatin (GC) combination (in GC versus C protocols and that comparing four doublets of CT). Results observed with G without platinum analogs are comparable to those of treatment with a platinum agent. Other studies conducted with triplets of CT need to be confirmed. Newer non-cytotoxic agents have also been studied: the anti-vascular endothelial growth factor monoclonal antibody with or without CT may prolong survival; docetaxel improves overall survival outcomes compared to palliative therapy. In locally advanced stages, advances have been made possible by radiochemotherapy (RT/CT): several phase II and phase III studies using EC and RT have been conducted. Lastly, in induction treatments, CT appears to provide improvement.