Advances in the Treatment of Lung Cancer

摘要

Advances in lung cancer research have led to changes in the standard of care. Most of these advances involve management approaches to nonsmall-cell lung cancer (NSCLC). Cure rates for early NSCLC have increased with the use of cisplatin-based postoperative chemotherapy. While chemotherapy continues to be the standard of care in advanced or metastatic disease, the integration of targeted agents has been feasible and has led to increased survival. The currently approved targeted agents include the vascular endothelial growth factor antibody bevacizumab, and the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib. Bevacizumab is used in combination with platinum-based chemotherapy in first-line therapy and erlotinib is used as a single agent in relapsed disease. Ongoing trials will evaluate the merit of these drugs in early disease. Inhibitors of multiple other targets are in varying stages of investigation. Increasing awareness of the unique toxicity profile has influenced the eligibility requirements for treatment with these agents. Biomarker discovery has led to the understanding of the biological heterogeneity of tumors and is quickly paving the path for individualized medicine. Such individualized therapy will have impact on both early and advanced disease with regard to treatment with not only targeted agents but also with cytotoxic chemotherapy. These biomarkers include excision repair cross-complementation group 1 (ERCC1), genomic profliling, EGFR protein, mutation, and gene expression. Individualized therapy will maximize the current modest benefit seen with standardized treatments. In small-cell lung cancer, the use of prophylactic cranial radiation has increased survival rates and quality of life in both limited and extensive stage disease. This review will address these recent advances in the treatment of lung cancer.