Non-Small Cell Lung Cancer Professional Information

TREATMENT OPTION OVERVIEW

In non-small cell lung cancer (NSCLC), results of standard treatment are poor in all but the most localized cancers. All newly diagnosed patients with NSCLC are potential candidates for studies evaluating new forms of treatment. Surgery is the major potentially curative therapeutic option for this disease; radiation therapy can produce cure in a small minority and palliation in the majority of patients. In advanced-stage disease, chemotherapy offers modest improvements in median survival although overall survival is poor.[1,2] Where studied, chemotherapy has been reported to produce short-term improvement in disease-related symptoms. In a single study, symptomatic relief with combination chemotherapy was significant but independent of objective response.[3,4] The impact of chemotherapy on quality of life requires more study.

Current areas under evaluation include combining local (surgery), regional (radiation therapy), and systemic (chemotherapy and immunotherapy) treatments and developing more effective systemic therapy. Several new agents, including paclitaxel (Taxol), docetaxel (Taxotere), topotecan, irinotecan, vinorelbine, and gemcitabine have been shown to be active in the treatment of advanced NSCLC. Chemoprevention of second primary cancers of the upper aerodigestive tract is also under active investigation in early-stage lung cancer.[5]

The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.

References:

1. Souquet PJ, Chauvin F, Boissel JP, et al.: Polychemotherapy in advanced non small cell lung cancer: a meta-analysis. Lancet 342(8862): 19-21, 1993.
2. Non-small Cell Lung Cancer Collaborative Group: Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. British Medical Journal 311(7010): 899-909, 1995.
3. Hardy JR, Noble T, Smith IE: Symptom relief with moderate dose chemotherapy (mitomycin-C, vinblastine and cisplatin) in advanced non-small cell lung cancer. British Journal of Cancer 60(5): 764-766, 1989.
4. Ellis PA, Smith IE, Hardy JR, et al.: Symptom relief with MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in advanced non-small-cell lung cancer. British Journal of Cancer 71(2): 366-370, 1995.
5. Pastorino U, Infante M, Maioli M, et al.: Adjuvant treatment of stage I lung cancer with high-dose vitamin A. Journal of Clinical Oncology 11(7): 1216-1222, 1993.

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