Treatment Options for Non-Small Cell Lung Cancer

Metastatic Non-Small Cell Lung Cancer (Stage IV)

The prognosis for patients with metastatic non-small cell lung cancer [NSCLC] (Stage IV) is extremely guarded with a 5-year estimated survival rate of only about 2%. At this stage of the disease there are no curative treatments and the objectives of treatment are primarily intended to relieve pain and other distressing symptoms and improve the patient's quality of life. This type of treatment is known as palliative therapy. Palliative therapy for patients with Stage IV NSCLC may include radiation therapy and/or chemotherapy.

Radiation Therapy

Radiation therapy is used to control pain that results from compression of the tumor on other organs such as the trachea, esophagus, or bronchi. Radiation therapy may also be used to relieve symptoms of pain resulting from the spread of the tumor to the brain or bones.

Chemotherapy

Often, patients with Stage IV NSCLC have other significant medical issues such as respiratory, cardiac, or other comorbidity that may preclude the use of palliative chemotherapy. For those patients who are fit for chemotherapy and have good performance status, a variety of chemotherapeutic regimens are available although, currently, none is considered to be "standard therapy". Some of the chemotherapeutic regimens that may be used as palliative therapy for patients with advanced non-small cell lung cancer include:

• Platinum-based chemotherapy - Examples of platinum-based drugs, which have been available since the early 1970s, include cisplatin and carboplatin. Although these drugs have been shown to improve quality of life in patients with advanced non-small cell lung cancer when compared to best supportive care, only a limited short-term survival benefit has been reported for patients with Stage IIIB or Stage IV NSCLC.

• Non-platinum based chemotherapy - Since 1990, a variety of newer, non-platinum-based drugs have been used for the treatment of advanced non-small cell lung cancer. These include:

  • paclitaxel (Taxol)
  • gemcitabine (Gemzar)
  • vinorelbine (Navelbine)
  • docetaxel (Taxotere)
  • irinotecan (CPT-11, Camptosar)

• Combination chemotherapy - More recently, combinations of platinum-based drugs (cisplatin or carboplatin) and non-platinum-based therapies (e.g., paclitaxel, gemcitabine, vinorelbine, docetaxel) have been evaluated in clinical trials. None of these combination regimens has been found to be superior in terms of significantly improving survival.