Treatment of non-small cell lung cancer

During the past three decades, treatment progress in small cell lung cancer (SCLC) has been modest and mainly achieved in patients staged as having limited disease (LD-SCLC) by the addition and refining of locoregional radiation to systemic chemotherapy. Three landmarks have been accomplished: (1) the addition of thoracic radiation therapy to systemic chemotherapy; (2) the demonstration of the superiority of early and/or twice-daily radiation therapy compared with late, once-daily fractionation; and ( 3 ) prophylactic radiation therapy of the brain, the so-called prophylactic cranial irradiation (PCI). Each of these innovations has contributed to an improvement of the 5-year survival rate in LD-SCLC. In contrast, progress in the treatment of patients with extensive disease (ED-SCLC) has been very modest. However, recently a significant step towards further improvement of palliative treatment has emerged with the demonstration that PCI also plays a definite role in the treatment of extensive disease. 1 Since the publication of Lung Cancer Therapy Annual 5, the historical background and current treatment of SCLC have been subjected to several reviews. 2-6 Moreover, updated clinical guidelines have been published by the National Comprehensive Cancer Network (NCCN), 7 the American College of Chest Physicians (ACCP), 8 the European Society for Medical Oncology (ESMO), 9 and the National Cancer Institute (NCI). 10 Certain areas of clinical research have been of particular interest. The optimal way to deliver chest radiotherapy remains unresolved; the definition of target volume, dose, fractionation, and timing of thoracic radiation is a matter of continuous debate and subject of several clinical studies. As for the development of new chemotherapeutic strategies, the results of clinical studies aimed at introducing the DNA topoisomerase I targeting drugs, e.g. topotecan and irinotecan, are emerging and, thus, yield new insights into the expansion of the treatment armentarium. As opposed to non-small cell lung cancer (NSCLC), the introduction of targeted therapies, such as mono-and polytargeted kinase inhibitors as well as immunotherapy has not yet led to significant, positive clinical outcomes.