From radiotherapy to Targeted therapy: 20 years in the management of non-small-cell lung cancer.
Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresectable disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.
Weiss
Glen J
GJ
Developmental Therapeutics Program, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA.
Bunn
Paul A
PA
Camidge
D Ross
DR
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D018450:Disease Progression; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D015996:Survival Rate; D016896:Treatment Outcome
D009944:Organoplatinum Compounds; D066246:ErbB Receptors; D040262:Receptors, Vascular Endothelial Growth Factor