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Vol 3, No 3 (2004): Polish Palliative Medicine
Artykuły poglądowe
Published online: 2004-04-27
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The role of systemic therapy in advanced lung cancer

Maciej Krzakowski
Advances in Palliative Medicine 2004;3(3):213-224.

open access

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.
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Keywords

non-small cell lung cancer (NSCLC); small cell lung cancer (SCLC); advanced stage; systemic therapy

About this article
Title

The role of systemic therapy in advanced lung cancer

Journal

Advances in Palliative Medicine

Issue

Vol 3, No 3 (2004): Polish Palliative Medicine

Pages

213-224

Published online

2004-04-27

Bibliographic record

Advances in Palliative Medicine 2004;3(3):213-224.

Keywords

non-small cell lung cancer (NSCLC)
small cell lung cancer (SCLC)
advanced stage
systemic therapy

Authors

Maciej Krzakowski

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