Chemotherapy for advanced (stage IIIB and stage IV) non-small cell lung cancer: the Hong Kong perspective.
Non-small cell lung cancer (NSCLC) accounts for about 80% of all primary lung cancers, and 60% of cases present as advanced stages IIIB and IV disease. Traditionally, treatment of stages IIIB and IV disease was only symptomatic (including radiotherapy) and supportive care, and cytotoxic chemotherapy was relatively ineffective. Our initial clinical trials, using MACC, FuAM, FAM, Hi-FAM and cisplatin-VP16, gave response rates of 5-20% and a stabilization rate of 7-25%, with no impact on median survival. Our most recent chemotherapy regimen MIP (mitomycin-C, ifosfamide and cisplatin) proved to be more effective with a 44% response rate and a 28% stabilzation rate, and produced a significantly longer median survival (32 weeks) than best supportive care alone (19.5 weeks, P< 0.05). The response rate further increased to 62.5% with dose intensification and GM-CSF support. Chemotherapy can now be recommended to motivated, well-informed patients with good performance status in institutions with experience in cancer chemotherapy on a protocol basis. The most recent addition of new effective cytotoxic agents such as paclitaxel, docetaxel, gemitabine and vinorelbine gave promising results in NSCLC, and optimal combinations and dose schedules are being defined by multicentred studies.
Lam
W K
WK
Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Tsang
K W
KW
Ip
M S
MS
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006723:Hong Kong; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D016019:Survival Analysis
D000970:Antineoplastic Agents