Anticancer treatment has recently shifted to include a broad range of
antineoplastic therapies. Old agents are continuously being re-evaluated, and new mechanisms of treatment are rapidly being explored and developed. At the same time, the patient's perceived quality of life, adverse effects of
therapy, time demands, and healthcare costs have become paramount in the treatment process.
Lung cancer is the most common cause of
cancer death in the USA, and because many of the patients are older or debilitated, these issues become all the more important. The
oral administration of anticancer
therapy offers both quality-of-life and healthcare cost advantages. Oral forms of 3 new
cytotoxic agents and 2 novel oral
therapies are discussed.
Vinorelbine, a vinca
alkaloid, has well documented activity in
non-small cell lung cancer. Myelosuppression is dose limiting; neurotoxicity is rare.
Satraplatin (JM-216), an oral
platinum derivative, shows activity in
lung cancer with a favourable adverse effect profile, with no neurotoxicity or nephrotoxicity. The oral
topoisomerase I inhibitor topotecan may be ideal for obtaining long term low plasma
drug concentrations, which appears to maximise efficacy.
LGD-1069 is a
retinoid X receptor agonist that modulates cell proliferation, and BAY-129566, a
matrix metalloproteinase inhibitor, appears to interrupt both the processes of angiogenesis and
metastasis.
LGD-1069 and BAY-129566 are nontraditional
anticancer agents which may be used in conjunction with
chemotherapy, other modalities, or in prevention. These 5 agents will be discussed with particular reference to recent developments in the treatment of
lung cancer.