Future Directions in Non-Small-Cell Lung Cancer: A Continuing Perspective
Non-small-cell lung cancer (NSCLC) will increasingly come under better control as the current approaches to therapy are more broadly employed and as new therapies are deployed against recently elucidated molecular
ABSTRACT: Non-small-cell lung cancer (NSCLC) will increasingly come under better control as the current approaches to therapy are more broadly employed and as new therapies are deployed against recently elucidated molecular pathways. In the United States, real progress is finally being made in decreasing tobacco consumption and in lung cancer incidence. The traditional chemotherapeutic compounds that became available earlier this decade (paclitaxel [Taxol], docetaxel [Taxotere], gemcitabine [Gemzar], vinorelbine [Navelbine], irinotecan [Camptosar], topotecan [Hycamtin], and edatrexate) have all been tested as single agents and as doublets with cisplatin (Platinol) and carboplatin (Paraplatin). Paclitaxel with cisplatin or carboplatin and vinorelbine, docetaxel, or gemcitabine with cisplatin have all demonstrated significant activity that now appears clearly better than the prior standard therapy of etoposide (VePesid)/cisplatin. Phase III studies sorting out their benefit relative to each other should be completed in the next 1 to 2 years. To date, no triplet therapy appears better than the corresponding doublet. Non-platinum-containing doublets are just completing their first round of assessments. Aside from new drugs and applications, the use of “small” molecules to inhibit either signal transduction pathways or gene activation is likely to accelerate. Most of the newer chemotherapeutic agents can be interdigitated with radiation and surgery, although evaluations into sequence and dose issues continue. The superior outcomes seen with the newer regimens should translate to the adjuvant and preoperative or preradiotherapy settings relatively quickly. It is now clear that NSCLC is as responsive to therapy as small-cell lung cancer (SCLC) and that outcomes are superior for NSCLC. The enthusiasm for treating SCLC displayed by nononcologists and nonthoracic medical oncologists should be shared for NSCLC.[ONCOLOGY 12(Suppl 2):90-96, 1998]
Despite the absence of any highly visible breakthrough presentation, the 8th World Conference on Lung Cancer in Dublin, Ireland, was a true watershed event. Trends that have been developing over the last decade have now become clear, and the need for new approaches is compelling. In the context of a continuing perspective on these meetings,[1] enormous progress has been made in the treatment of non-small-cell lung cancer (NSCLC), in the understanding of the molecular events leading to lung cancer, and in the war against tobacco. Complacency based on these advances would, however, be folly. The continued lack of progress against small-cell lung cancer (SCLC), the absence of major progress in diagnostic imaging, and the continued slow pace of translating biologic understanding to clinical application are frustrating. Underlying all of this is our inability to complete pivotal randomized trials in a timely fashion.
Internal server error