Since the 1980s,
cisplatin therapy for advanced
non-small-cell lung cancer (NSCLC) has shown improvement in patient outcome with respect to overall survival. In the past decade, several new agents, such as the
taxanes (
paclitaxel and
docetaxel),
gemcitabine,
vinorelbine, and
irinotecan, have also shown promising single-agent efficacy in the treatment of advanced NSCLC. Superior efficacy was observed when these 5 agents were used in combination with
cisplatin as compared to
cisplatin alone for treatment of patients with NSCLC. The toxicity profiles of these 5 agents were found to be largely nonoverlapping with
cisplatin. The results of recent randomized trials with different
cisplatin-based
chemotherapy regimens have shown that
platinum-based
therapy is still the mainstay for treatment of NSCLC; however, it appears that a
chemotherapy efficacy plateau has been reached. Moreover, it has also been shown that for patients unable to tolerate
cisplatin, nonplatinum doublets consisting of
gemcitabine with either
taxanes or
vinorelbine are equivalent in efficacy and can be alternatives for first-line treatment of advanced NSCLC. Thus, the development of new and novel strategies is essential for treatment of NSCLC patients. Ongoing trials with
vaccines, signal transduction modulators,
antiangiogenic agents, and gene therapy in combination with
chemotherapy