Optimizing First-Line Treatment Options for Patients with Advanced NSCLC

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Explain the clinical implications of large randomized trials evaluating chemotherapy combinations for patients with advanced NSCLC.Summarize the activity and toxicity of current chemotherapy regimens for the first-line treatment of advanced NSCLC.Describe regimens that have quality-of-life benefits in the treatment of NSCLC.Identify potential future standards of care for advanced disease based on recent research findings evaluating novel targeted agents. Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com The median survival time for advanced non-small cell lung cancer (NSCLC) remains poor, despite years of research into new chemotherapy combinations. Platinum-based chemotherapy has long been the standard of care for the initial treatment of advanced NSCLC. While no one particular platinum-based chemotherapy regimen is definitely superior to the others (as demonstrated in the Eastern Cooperative Oncology Group's E1594 trial), three randomized phase III trials (the Southwest Oncology Group 9509, Italian Lung Cancer Project, and TAX326 trials) have recently demonstrated that taxane–platinum doublets are better tolerated than a combination of vinorelbine and cisplatin (VC). Moreover, a combination of docetaxel and cisplatin produced superior survival and quality of life than VC in the TAX326 study. Nonplatinum combinations, such as a taxane–gemcitabine doublet, appear promising and better tolerated than their platinum-based comparators in other studies. Efforts to evaluate chemotherapy specifically in elderly patients and in those with poor performance status (PS) have increased. Single-agent chemotherapy has been safely administered to these populations, but platinum-based doublet therapy may also be feasible in both elderly patients and patients with PS scores of 2. The addition of the monoclonal antibody against vascular endothelial growth factor, bevacizumab, to standard chemotherapy for patients with non-squamous cell advanced NSCLC significantly extended median survival in the E4599 randomized trial. Each incremental advance demonstrates that progress can be made in first-line treatment of advanced NSCLC.

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