New chemotherapeutic agents prolong survival and improve quality of life in non-small cell lung cancer: a review of the literature and future directions.

In past years, there has been considerable pessimism over the role of chemotherapy in non-small cell lung cancers. The pessimism was largely derived from the fact that alkylating agent-based therapies shortened survival and produced severe side effects. This was especially important because the vast majority of patients (approximately 85%) develop metastatic disease during their course. Randomized trials from the 1980s showed that cisplatin-based chemotherapy improved patient survival, improved quality of life as assessed by the patients, and relieved symptoms in the majority of symptomatic patients. When chemotherapy was administered on an outpatient basis, it actually lowered the total patient care costs for advanced stage patients. In the 1990s, five new agents, including two taxanes (paclitaxel, docetaxel), gemcitabine, navelbine, and irinotecan, were shown to produce higher response rates and longer survival in Phase II trials compared to cisplatin or carboplatin. In randomized trials, combinations of paclitaxel, gemcitabine, and vinorelbine with cisplatin improved the survival of advanced stage patients compared to cisplatin alone or in combination with etoposide. The toxicity profile of the new agents is also favorable compared to cisplatin-based therapy. Preliminary results in earlier stages are also encouraging. Thus, currently available chemotherapy given to non-small cell lung cancer patients with good performance status can improve survival to a similar extent as other solid tumors, such as small cell lung cancer and breast cancer.