The global role of irinotecan in the treatment of lung cancer: 2003 update.

Lung cancer is the most lethal malignancy in the United States. In light of its natural history, new agents with improved systemic activity are needed. Irinotecan (CPT-11, Camptosar) is a promising agent in the treatment of advanced non-small-cell and small-cell lung cancer. In subgroup analysis of a Japanese phase III trial, irinotecan or irinotecan/cisplatin demonstrated a significant survival advantage compared with standard vindesine (Eldisine)/cisplatin in advanced non-small-cell lung cancer. Similar North American phase III trials focusing on irinotecan's role in non-small-cell lung cancer are planned. Ongoing trials have also been inaugurated to corroborate the significant survival advantage reported by a Japanese phase III trial of irinotecan/cisplatin vs standard etoposide/cisplatin in extensive small-cell lung cancer. Current and planned trials in patients with non-small-cell lung cancer will investigate treatment using irinotecan in combination with gemcitabine (Gemzar), the taxanes, and other new agents, as well as with thoracic radiotherapy. Moreover, trials in small-cell lung cancer are investigating the utility of irinotecan in combination with a platinum agent when incorporated in chemoradiotherapy regimens. It is hoped that data from these and other studies will help investigators to more clearly delineate a role for irinotecan in the management of lung cancer.