Rationale for the treatment of non-small cell lung cancer

Abstract

The vast numbers of patients with non-small cell lung cancer (NSCLC) worldwide deserve more than the prevailing attitude of therapeutic nihilism. Although 5-year survival for all but Stage I NSCLC patients is poor, the cumulative evidence from randomised trials of chemotherapy in patients with advanced disease suggests that a very modest increase in median survival time is possible and that a small number of patients survive to 2 years. Furthermore, trials that have evaluated the effect of chemotherapy on cancer-related symptoms have shown a far greater proportion of patients benefiting from symptom relief than would have been surmised from the usually reported objective response rates. more effective supportive care measures have dramatically reduced the frequency of intolerable treatment-related side effects, making a trial of chemotherapy a more reasonable proposition for the symptomatic, good performance status patient. Finally, an economic analysis of the costs of chemotherapy in the setting of advanced NSCLC has demonstrated that the cost of treatment may actually be less than best supportive care in some instances and, in any event, the costs of chemotherapy are not excessively expensive compared with many other commonly accepted nononcologic medical practices.