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Nonplatinum-Based Chemotherapy for Advanced Non-Small Cell Lung Cancer

Mok, Tony S. K. MD, FRCPC; Chan, Anthony T. C. MD, FRCP

Clinical Pulmonary Medicine: May 2003 - Volume 10 - Issue 3 - p 143-153
doi: 10.1097/01.cpm.0000059369.04504.d5
COLLEAGUES IN RESPIRATORY MEDICINE
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The new generation of cytotoxic drugs, such as gemcitabine, docetaxel, paclitaxel, vinorelbine, and irinotecan, plays an crucial role in the management of advanced non-small cell lung cancer. Single-agent therapy has been shown to palliate symptoms, improve quality of life, and defer radiotherapy, but does not necessarily prolong survival in chemotherapy-naïve patients. On the other hand, single-agent docetaxel may prolong survival when given as second-line therapy in patients who have failed platinum-based regimens. Many phase II studies have demonstrated that the gemcitabine- or taxane-based nonplatinum combinations are highly effective in the induction of tumor response and are able to attain survival prolongation. Two published randomized phase III studies comparing nonplatinum-based to platinum-based chemotherapy have reported equal efficacy, but interim results from two other ongoing comparative studies have suggested the nonplatinum-based regimens to be inferior. The current available data do not necessarily support general use of nonplatinum-based regimens in patients with advanced non-small cell lung cancer, but selected patients may benefit.

Platinum-based combination chemotherapy is the current standard of treatment for advanced non-small cell lung cancer. A new generation of cytoxic drugs may potentially achieve the same objective of survival prolongation with less toxicity. This article reviews clinical trials that study the efficacy of nonplatinum-based chemotherapy and define their role in the management of advanced non-small cell lung cancer.

From the Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.

Address correspondence to: Tony S. K. Mok, MD FRCPC, Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China. Address e-mail to: mok206551@cuhk.edu.hk

© 2003 Lippincott Williams & Wilkins, Inc.