New developments in chemotherapy for advanced non-small cell lung cancer.
OBJECTIVE
The treatment of patients with advanced non-small cell lung cancer has changed considerably in the past decade. This paper reviews the most significant changes seen in chemotherapy and the most promising new agents in development for this disease.


RESULTS
Chemotherapy prolongs survival and improves quality of life in patients with a good performance status and appears to alleviate disease-related symptoms in patients with a lower performance status. Platinum-based regimens became standard; none of the third-generation drug combinations seemed to be superior to the others. Nonplatinum combinations are reasonable alternatives now and offer a better toxicity profile in certain populations. Attempts to add molecular-targeted therapy to combination chemotherapy have failed except for bevacizumab. New compounds such as pemetrexed, bortezomib, TLK286, bevacizumab, and the epothilones are currently being evaluated in non-small cell lung cancer.


CONCLUSIONS
Management of non-small cell lung cancer has improved considerably in the past decade. The overall benefit of chemotherapy over supportive care has been shown, platinum-based doublets have been established, nonplatinum regimens have been developed, chemotherapy has been used more broadly in subgroups of patients who have been previously neglected, and a shorter chemotherapy duration has been shown to be equally effective. After hitting a plateau in the benefit of chemotherapy, new drugs with novel action mechanisms such as the ones described here offer hope to improve therapy for this disease.
Raez
Luis E
LE
University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, The Mount Sinai Cancer Center, Florida, USA. LRaez@med.miami.edu
Lilenbaum
Rogerio
R
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D034261:Epothilones / Q000627:therapeutic use; D005971:Glutamates / Q000627:therapeutic use; D005978:Glutathione / Q000031:analogs & derivatives / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000627:therapeutic use; D000068437:Pemetrexed; D011719:Pyrazines / Q000627:therapeutic use
D000970:Antineoplastic Agents; D001897:Boronic Acids; D034261:Epothilones; D005971:Glutamates; D009944:Organoplatinum Compounds; D011719:Pyrazines; D000068437:Pemetrexed; D000077150:Oxaliplatin; C107479:TER 286; D006147:Guanine; D000069286:Bortezomib; D005978:Glutathione; D017239:Paclitaxel