Chemotherapy Treatments

Chemotherapy employs drugs given orally or by injection to destroy cancer cells that may have gone beyond the tumor. Until recently there has been some doubt about the effectiveness of chemotherapy for lung cancer. A major 2002 analysis of 52 trials supported its use, particularly with platinum-based regimens and when supportive care was employed.

• Chemotherapy in Early Stages. Chemotherapy is proving to be beneficial in many patients as an additional treatment with surgery or radiation.
• Chemotherapy in Advanced Disease. Chemotherapy may be used as first-line therapy in patients with inoperable or metastasized lung cancer. It is typically used in late stages to reduce symptoms and, in some cases, extend survival.

Chemotherapy Drugs and Regimens

Powerful platinum compounds, either cisplatin (Platinol) or carboplatin (Paraplatin), are the basis for most chemotherapy regimens. Two-drug combinations, with one drug being a platinum-based agent, are currently the preferred regimens. Reasonable combinations include paclitaxel (Taxol) and carboplatin or cisplatin with gemcitabine, docetaxol, or vinblastine or a derivative (vindesine or vinorelbine). There does not seem to be any significant differences in effectiveness among them, however. For elderly patients who cannot tolerate platinum compounds, gemcitabine and vinorelbine combination therapy may play a role.

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Chemotherapy for lung cancer may have reached its peak. Still, investigative chemotherapeutic agents may yet improve response. Many experts are pinning their hope on agents called biologic response modifiers, such as gefitinib (Iressa) or LY900003 (Affinitak). To date, however, they have not achieved better results than standard platinum-based chemotherapies and gefitinib may be withdrawn from the market due to unfavorable survival results.

Administration, Timing, and Drug Sequences