J Korean Med Assoc.  2003 Jan;46(1):38-45. 10.5124/jkma.2003.46.1.38.

Chemotherapy in Lung Cancer

• Park KC

• KMID: 2183063
• DOI: http://doi.org/10.5124/jkma.2003.46.1.38

Abstract

Non-small cell lung cancer: As most patients with non-small cell lung cancer present with nonsurgically curable diseae, major efforts have been made in the treatment of advanced non-small cell lung cancer (NSCLC) with chemotherapy. Controlled studies of platinum-based chemotherapy vs. supportive care showed statistically significant improvements in survival. During the last several years, the introduction of several new chemotherapeutic agents, such as the taxanes, gemcitabine, vinorelbine, and irinotecan has resulted in improved survival and quality of life for patients with advanced NSCLC. However, the superiority of a regimen in terms of improved survival, quality of life, and toxicity profile has still remained unclear. Newer, targeted therapies hold promise to improve outcome without adding a great deal of additional toxicity. Small cell lung cancer: Small cell lung cancer (SCLC) is characterized by early dissemination and a rapid, aggressive clinical course. The role of combination chemotherapy in patients with SCLC was well established since 1970's; however, no trend toward longer survival has been observed during the last decade. Even if the use of adjunctive radiation therapy does not help in extending survival in extensive-disease, the use of chemotherapy without radiation therapy is to be discouraged in patients with limited-disease, because randomized trials showed a definite survival advantage for combined modality therapy. In terms of the choice of chemotherapy, etoposide/cisplatin or etoposide/carboplatin have emerged as the regimens of choice because they offer a good therapeutic index and can be combined with radiotherapy. Recently, several active agents such as taxanes, topotecan, vinorelbine, and irinotecan have been used in SCLC.

Keyword

Lung cancer; Chemotherapy

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Combined Modality Therapy
Drug Therapy*
Drug Therapy, Combination
Humans
Lung Neoplasms*
Lung*
Quality of Life
Radiotherapy
Small Cell Lung Carcinoma
Taxoids
Topotecan
Taxoids
Topotecan

Reference

1. Ihde DC. Chemotherapy of lung cancer. N Engl J Med. 1992. 327:1434–1441.

2. Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a metaanalysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995. 311(7010):899–909.

3. Thongprasert S, Sanguanmitra P, Juthapan W, Clinch J. Relationship between quality of life and clinical outcomes in advanced non-small cell lung cancer: best supportive care (BSC) versus BSC plus chemotherapy. Lung Cancer. 1999. 24(1):17–24.

4. Ranson M, Davidson N, Nicolson M, Falk S, Carmichael J, Thatcher N, et al. Randomized trial of paclitaxel plus supportive care versus supportive care for patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 2000. 92(13):1074–1080.

5. Roszkowski K, Pluzanska A, Krzakowski M, Smith AP, Saigi E, Berille J, et al. A multicenter, randomized, phase III study of docetaxel plus best supportive care versus best supportive care in chemotherapy-naive patients with metastatic or non-resectable localized non-small cell lung cancer (NSCLC). Lung Cancer. 2000. 27(3):145–157.

6. Bonomi PD, Finkelstein DM, Ruckdeschel JC, Blum RH, Green MD, Comis R, et al. Combination chemotherapy versus single agents followed by combination chemotherapy in stage IV non-small-cell lung cancer: a study of the Eastern Cooperative Oncology Group. J Clin Oncol. 1989. 7(11):1602–1613.

7. Klastersky J, Sculier JP, Lacroix H, Dabouis G, Bureau G, Thiriaux J, et al. A randomized study comparing cisplatin or carboplatin with etoposide in patients with advanced non-small-cell lung cancer: European Organization for Research and Treatment of Cancer Protocol 07861. J Clin Oncol. 1990. 8(9):1556–1562.

8. Iaffaioli RV, Tortoriello A, Facchini G, Caponigro F, Gentile M, Illiano A, et al. Phase I-II study of gemcitabine and carboplatin in stage IIIB-IV non-small-cell lung cancer. J Clin Oncol. 1999. 17(3):921–926.

9. Sandler AB, Nemunaitis J, Denham C, von Pawel J, Cormier Y, Einhorn LH, et al. Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2000. 18(1):122–130.

10. Cardenal F, Lopez-Cabrerizo MP, Anton A, Alberola V, Massuti B, Rosell R, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 1999. 17(1):12–18.

11. Crino L, Scagliotti GV, Ricci S, De Marinis F, Rinaldi M, Tonato M, et al. Gemcitabine and cisplatin versus mitomycin, ifosfamide, and cisplatin in advanced non-small-cell lung cancer: A randomized phase III study of the Italian Lung Cancer Project. J Clin Oncol. 1999. 17(11):3522–3530.

12. Le Chevalier T, Pujol JL, Douillard JY, Alberola V, Monnier A, Besson F, et al. A three-arm trial of vinorelbine (Navelbine) plus cisplatin, vindesine plus cisplatin, and single-agent vinorelbine in the treatment of non-small cell lung cancer: an expanded analysis. Semin Oncol. 1994. 21(5):Suppl 10. 28–33.

13. Wozniak AJ, Crowley JJ, Balcerzak SP, Weiss GR, Spiridonidis CH, Livingston RB, et al. Randomized trial comparing cisplatin with cisplatin plus vinorelbine in the treatment of advanced non-small-cell lung cancer: a Southwest Oncology Group study. J Clin Oncol. 1998. 16(7):2459–2465.

14. Bonomi P, Kim K, Fairclough D, Cella D, Kugler J, Johnson D, et al. Comparison of survival and quality of life in advanced non-small-cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2000. 18(3):623–631.

15. Gandara DR, Vokes E, Green M, Bonomi P, Devore R, Belani C, et al. Activity of docetaxel in platinum-treated non-small-cell lung cancer: results of a phase II mul -ticenter trial. J Clin Oncol. 2000. 18(1):131–135.

16. Fossella FV, DeVore R, Kerr RN, Crawford J, Natale RR, Hammershaimb L, et al. The TAX 320 Non-Small Cell Lung Cancer Study Group. Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. J Clin Oncol. 2000. 18(12):2354–2362.

17. Kelly K, Crowley J, Bunn PA Jr, Presant CA, Grevstad PK, Gandara DR, et al. Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non-small-cell lung cancer: a Southwest Oncology Group trial. J Clin Oncol. 2001. 19(13):3210–3218.

18. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Johnson DH, et al. The Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002. 346(2):92–98.

19. DeVita Vincent T Jr, Hellman Samuel, Rosenberg Steven A. Cancer principles and practice of oncology. 2001. 6th ed. Lippincott-Williams & Wilkins;983–1018.

20. Perry MC, Eaton WL, Propert KJ, Ware JH, Zimmer B, Faulkner C, et al. Chemotherapy with or without radia -tion therapy in limited small-cell carcinoma of the lung. N Engl J Med. 1987. 316(15):912–918.

21. Pignon JP, Arriagada R, Ihde DC, Johnson DH, Perry MC, Lebeau B, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med. 1992. 327(23):1618–1624.

22. Carlson RW, Sikic BI, Gandara DR, Hendrickson CG, Wittlinger PS, McWhirter KM, et al. Late consolidative radiation therapy in the treatment of limited-stage small cell lung cancer. Cancer. 1991. 68(5):948–958.

23. Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Saijo N, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol. 2002. 20(14):3054–3060.

24. Murray N, Coy P, Pater JL, Hodson I, Arnold A, Dixon P, et al. The National Cancer Institute of Canada Clinical Trials Group. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. J Clin Oncol. 1993. 11(2):336–344.

25. Perry MC, Herndon JE 3rd, Eaton WL, Green MR. Thoracic radiation therapy added to chemotherapy for small-cell lung cancer: an update of Cancer and Leukemia Group B Study 8083. J Clin Oncol. 1998. 16(7):2466–2467.

26. Auperin A, Arriagada R, Pignon JP, Le Pechoux C, Gregor A, Aisner J, et al. Prophylactic Cranial Irradiation Overview Collaborative Group. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. N Engl J Med. 1999. 341(7):476–484.

27. Souhami RL, Rudd R, Ruia de Elvira MC, James L, Gower N, Trask C, et al. Randomized trial comparing weekly versus 3-week chemotherapy in small-cell lung cancer: a Cancer Research Campaign Trial. J Clin Oncol. 1994. 12:1806–1813.

28. Medical Research Council Working Party. Comparison of oral etoposide and standard intravenous multidrug chemotherapy for small cell lung cancer: a stopped multicenter randomised trial. Lancet. 1996. 348:563–566.

29. Klasa RJ, Murray N, Coldman AH. Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. J Clin Oncol. 1991. 9:499–508.

30. Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Saijo N, et al. The Japan Clinical Oncology Group. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med. 2002. 346(2):85–91.

31. von Pawel J, Gatzemeier U, Pujol JL, Moreau L, Bildat S, Ross G, et al. Phase ii comparator study of oral versus intravenous topotecan in patients with chemosensitive small-cell lung cancer. J Clin Oncol. 2001. 19(6):1743–1749.