Chemotherapy in Advanced Stage Non-small Cell Lung Cancer - Have We Got the Evidence

摘要

Lung cancer is the leading cause of cancer death in the world, including the Asian-Pacific region. The prognosis of patients with non-small cell lung cancer is poor with median survival time of only 3 to 5 months. Many randomized trials and meta-analysis before 1995 documented that cisplatin-based conventional chemotherapy significantly prolonged patient's survival for 1-2 months. Clinical trials using third-generation new anti-cancer drugs against non-small cell lung cancer were noted after 1990. It was found that these new chemotherapeutic agents have improved survival and quality of life with reduced toxicity compared with conventional cisplatin-based regimens. Randomized trials support the use of two-drug combinations for patients with performance status of 0 and 1, and perphas 2. These two-drug combinations should contain platinum compound and one new agent. Triplet therapy is not better than doublet treatment at present time. After many randomized trials, which new agent is better for combination with platinum compound is still unkown. Non-platinum containing regimen (such as combination of two new agents) probably had less treatment-related toxicities and thus produced better quality of life, however, at the cost of slightly less or equal survival time. It was summarized that new anti-cancer drugs used for patients with advanced NSCLC had achieved improvement in survival for 4-6 months, comparing with best supportive care. However, further studies with new agents, such as targeted therapy is still needed.