Cisplatin (
Platinol; Bristol-Myers Squibb, Princeton, NJ, http://www.bms.com) and
carboplatin (
Paraplatin; Bristol-Myers Squibb), together with newer
chemotherapies, such as
docetaxel (
Taxotere; Aventis
Pharmaceuticals Inc., Bridgewater, NJ, http://www.aventispharma-us.com),
paclitaxel (
Taxol; Bristol-Myers Squibb),
vinorelbine (
Navelbine; GlaxoSmith-Kline, Philadelphia, http://www.gsk.com),
pemetrexed (
Alimta; Eli Lilly and Company, Indianapolis, http://www.lilly.com), and
gemcitabine (
Gemzar; Eli Lilly and Company), have improved treatment outcomes in both advanced
non-small cell lung cancer (NSCLC) and in the adjuvant/neoadjuvant setting. Newer systemic treatments for NSCLC, used in advanced stage IV management, are beginning to be studied in earlier stages of the disease, when treatment is better tolerated and potentially curative. Hopefully, newer agents with proven efficacies in advanced disease will enhance curability. Following the successful addition of
bevacizumab (
Avastin; Genentech, Inc., South San Francisco, CA, http://www.gene.com) to
carboplatin/
paclitaxel in advanced disease,
bevacizumab is now being incorporated into adjuvant and neoadjuvant trials. Trials in stage IB-IIIA patients will study neoadjuvant
docetaxel/
cisplatin/
bevacizumab. The discovery that patients with exon 19 and 21 mutations in the
epidermal growth factor receptor gene EGFR have around an 80% response rate to
gefitinib (
Iressa; AstraZeneca
Pharmaceuticals, Wilmington, DE, http:// www.astrazeneca-us.com) and that this response confers survival benefit indicates its potential utility for mutation-positive patients with advanced- and earlier-stage disease. Clinical characteristics, such as never smoking status and
adenocarcinoma, and especially
bronchioloalveolar carcinoma histological features, can also identify individuals likely to respond to EGFR
tyrosine kinase inhibitors. Studies of neoadjuvant
erlotinib (
Tarceva; OSI
Pharmaceuticals, Inc., Melville, NY, http://www.osip.com) in operable NSCLC are planned. One such study includes
cisplatin and
docetaxel. Effective development of active agents and disease management based on molecular profiling of lung
tumors will change tomorrow's standard of care.