Lung Cancer.pdf

180 R. Zinner
KEY PRACTICE POINTS
• Chemotherapy doublets consisting of platinum compounds plus thirdgeneration
agents are the current standard of care for patients with
advanced NSCLC who have good PS (a PS score of 0 or 1) and are less than
70 years of age.
• The wide variety of platinum–third-generation doublets studied to date have
similar survival profiles; therefore, in the choice of doublets, the prime considerations
are toxicity, convenience of administration, and cost.
• Nonplatinum-containing doublets and chemotherapy triplets have shown
promise in some clinical trials but are not yet established.
• In newly diagnosed younger patients with good PS, there is evidence that
treatment beyond 3 to 4 courses of platinum-containing regimens produces
no survival benefit but increases the incidence of side effects.
• Maintenance therapy with vinorelbine has not been demonstrated to offer
benefit. However, there are anecdotal accounts of benefit from treatment
sustained beyond 8 courses. Therefore, this practice, though not standard,
can be considered on a case-by-case basis.
• Older patients with good PS may benefit from the regimens used in younger
patients, but patients who are much older than 70 years have not been fully
evaluated in clinical studies and may best benefit from monotherapy with
third-generation agents, such as vinorelbine and gemcitabine.
• Docetaxel at 75 mg/m2 every 3 weeks is the standard of care as second-line
treatment, including in patients previously treated with paclitaxel.
• Opportunities for enrollment in clinical trials of promising new agents have
never been better and should be emphasized whenever treatment is being
considered.
Suggested Readings
Albain KS, Crowley JJ, Hutchins L, et al. Predictors of survival following relapse or
progression of small cell lung cancer. Southwest Oncology Group Study 8605
report and analysis of recurrent disease data base. Cancer 1993;72:1184–1191.
Albain KS, Crowley JJ, LeBlanc M, et al. Survival determinants in extensive-stage
non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin
Oncol 1991;9:1618–1626.
Alberola V, Camps C, Provencia M, et al. Cisplatin/gemcitabine (CG) vs cisplatin/gemcitabine/vinorelbine
(CGV) vs sequential doublets of gemcitabine/vinorelbine
followed by ifosfamide/vinorelbine (GV/IV) in advanced
non-small cell lung cancer (NSCLC): results of a Spanish Lung Cancer Group
phase III trial (GEPC/98–02). Proc Am Soc Clin Oncol 2001;42. Abstract 1229.
American Society of Clinical Oncology. Clinical practice guidelines for the treatment
of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by
the American Society of Clinical Oncology. J Clin Oncol 1997;15:2996–3018.