Chemotherapeutic options in lung cancer

Lung carcinoma is the leading cause of cancer death in both men and women, accounting for 29% of all cancer deaths. There are no established screening measures, no established prevention agents, and current systemic therapies, such as cytotoxic chemotherapy, fail to cure metastatic disease. The cure rate is a low 14%. A review of past and present literature was performed to discuss new measures used for early detection, primary and secondary prevention, and therapeutic options of lung carcinoma. The vast majority of lung carcinomas are caused by active tobacco smoking. The death rate is declining in men but rising in females. Primary preventions to stop individuals from smoking include Food and Drug Administration regulation of nicotine use and tobacco advertising and educational programs aimed at the younger population. One-half of lung carcinomas occur in former smokers. Beta carotene, as a chemoprevention agent, paradoxically increased lung carcinoma incidence and mortality. Early promising results were obtained with vitamin A and selenium as potential chemoprevention agents. Analysis of sputum of high risk individuals using new methods, such as analysis of multiple cell parameters, cell surface antigen analysis, molecular analyses using fluorescent in situ hybridization techniques, and fluoroscopic bronchoscopy to detect early lesions, can be effective as screening measures. The majority of patients who are cured have early stages (I and II), which can be resected completely at thoracotomy. Yet, the majority of patients who undergo a complete surgical resection still later fail in distant sites. Older postoperative, adjuvant, cisplatin-based chemotherapies reduced the hazard rates of death by 13%. New agents are now under evaluation. Postoperative radiotherapy reduced the rate of local recurrence but had no impact on distant failure rate. Combined modality therapy with chemotherapy and radiotherapy increased the survival of patients with Stage III nonsmall cell lung carcinoma, increasing median survival by about 4 months and 5-year survival from 5% to as much as 20%. In Stage IV patients, cisplatin-based chemotherapies improved survival, relieved symptoms in the majority of patients, improved quality of life, and was cost effective compared with other therapies. New chemotherapeutic agents, such as vinorelbine, the taxanes paclitaxel and docetaxel, and gemcitabine, as single agents and in combination with platinum agents, have equivalent or higher response rates and longer survival compared with prior cisplatin-based combinations. There are signs that the therapeutic outlook for lung carcinoma is changing with newer methods available to detect early disease. New chemotherapeutic agents with less toxicity alone or in combination with either radiotherapy or surgery can improve survival and quality of life for advanced lung carcinoma patients and may increase the cure rate for earlier stage patients.