Vol 3, No 3 (2004): Polish Palliative Medicine
Artykuły poglądowe
Published online: 2004-04-27
The role of systemic therapy in advanced lung cancer
Maciej Krzakowski
Advances in Palliative Medicine 2004;3(3):213-224.
Vol 3, No 3 (2004): Polish Palliative Medicine
Artykuły poglądowe
Published online: 2004-04-27
Abstract
There are two types of lung cancer, non-small cell and small cell. The role of systemic therapy in the
management of patients with advanced stage non-small cell lung cancer (NSCLC) and small cell lung cancer
(SCLC) is palliation of symptoms and life prolongation.
In the past many patients with advanced NSCLC received no active systemic therapy, since its toxicity was
considered to outweigh the benefits. It is now evident, however, that modern systemic therapy for advanced
NSCLC may produce moderate survival and quality of life gains in restricted subgroups of patients.
The question now is not only the use of platinum-containing first-line chemotherapy for advanced NSCLC,
as some patients can benefit from second-line cytotoxic therapy or molecular-oriented therapies.
In contradistinction to NSCLC, SCLC is considered a highly chemo-sensitive malignancy and chemotherapy
alone, consisting of a combination of cisplatin and etoposide, is the commonly accepted treatment of
choice for extensive disease. Several recent studies have shown some benefit from the addition of irinotecan
or paclitaxel for extensive SCLC. Other agents, active against relapsed SCLC, are being evaluated for first-line
use in advanced SCLC. Since little further progress is expected with the use of traditional cytoxic agents, future directions for
treatment of both SCLC and NSCLC are directed toward targeted therapies, aimed at patient-specific
molecular abnormalities.
Abstract
There are two types of lung cancer, non-small cell and small cell. The role of systemic therapy in the
management of patients with advanced stage non-small cell lung cancer (NSCLC) and small cell lung cancer
(SCLC) is palliation of symptoms and life prolongation.
In the past many patients with advanced NSCLC received no active systemic therapy, since its toxicity was
considered to outweigh the benefits. It is now evident, however, that modern systemic therapy for advanced
NSCLC may produce moderate survival and quality of life gains in restricted subgroups of patients.
The question now is not only the use of platinum-containing first-line chemotherapy for advanced NSCLC,
as some patients can benefit from second-line cytotoxic therapy or molecular-oriented therapies.
In contradistinction to NSCLC, SCLC is considered a highly chemo-sensitive malignancy and chemotherapy
alone, consisting of a combination of cisplatin and etoposide, is the commonly accepted treatment of
choice for extensive disease. Several recent studies have shown some benefit from the addition of irinotecan
or paclitaxel for extensive SCLC. Other agents, active against relapsed SCLC, are being evaluated for first-line
use in advanced SCLC. Since little further progress is expected with the use of traditional cytoxic agents, future directions for
treatment of both SCLC and NSCLC are directed toward targeted therapies, aimed at patient-specific
molecular abnormalities.
Keywords
non-small cell lung cancer (NSCLC); small cell lung cancer (SCLC); advanced stage; systemic therapy
Keywords
non-small cell lung cancer (NSCLC)
small cell lung cancer (SCLC)
advanced stage
systemic therapy
Authors
Maciej Krzakowski
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