Abstract
The cornerstone of the treatment of metastatic non-small cell lung cancer (NSCLC) is cytotoxic chemotherapy, given either as a platinum-based doublet for chemotherapynaive patients or as a single agent for patients with previously treated disease. Despite extensive testing of different combination regimens over the past two decades, the overall improvements in terms of patient survival have been modest. 1 To illustrate this point, four standard platinum-based regimens were compared in a randomized trial of 1155 patients with untreated advanced inoperable NSCLC. 2 There were no statistically significant differences in response rates or 1-year, 2-year, or overall survival between the different regimens. Similarly, no differences in response rates, median survival, or 1-year survival were seen in a large randomized trial comparing docetaxel and pemetrexed in patients with previously treated NSCLC.3It appears that a plateau in efficacy has been achieved with cytotoxic chemotherapy, and new therapeutic approaches are needed.
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