The value of
platinum compounds has come into question with the advent of newer
chemotherapy agents in the management of patients with advanced
non-small-cell lung cancer. These newer agents, which include the
taxanes,
topoisomerase I inhibitors,
gemcitabine, and
vinorelbine, appear to have higher single-agent response rates and more favorable toxicity profiles when compared to the
platinum compounds. However, the toxicity of the
platinum compounds is now minimized with the advent of more effective
antiemetics. In addition, phase III clinical trials have demonstrated that the strategy of
cisplatin dose intensity and prolonged
duration of therapy with
platinum compounds does not improve overall survival; therefore, moderate doses of
cisplatin and a shorter
duration of therapy can be given to further decrease toxicity. Furthermore, while phase II trials utilizing nonplatinum-based
combination chemotherapy appear to demonstrate superior response rates and survival in comparison to
platinum-based doublets, results of phase III trials have demonstrated no improvement in survival.
Platinum combination chemotherapy remains the standard approach for stage IV
non-small-cell lung cancer. More substantial advances will likely be made with novel
molecular targeted therapy, such as the
epidermal growth factor receptor inhibitors, which demonstrate synergy with the
platinum compounds.