HEMATOLOGICALONCOLOGY, VOL. 10,2>30 (1992)

CHEMOTHERAPY OF METASTATIC NON-SMALL CELL CARCINOMA OF THE LUNG JOHN c. RUCKDESCHEL* Division of Medical Oncology, Albany Medical College. A-167,47 New Scotland Avenue, Albany, N Y 12208. U.S.A.

INTRODUCTION Metastatic, non-small cell lung cancer (NSCLC) remains one of the most lethal illnesses facing modern medicine, both in its impact on the individual patient and in its impact on society as a whole. In any algorithm leading to potentially curative therapy for NSCLC there are always arrows leading away from the curative pathway in the direction of metastatic disease (Figure 1). The majority of patients with metastatic disease are discovered by history and physical exam, although radiographic and surgical staging frequently contribute cases not initially apparent. When one reaches the point of confirmed metastatic NSCLC there is one further branch in the algorithm (Figure 2); the decision between palliation with chemotherapy or best supportive care (BSC) without chemotherapy. A critical element in this decision is, of course, the patients desire to pursue a therapy that will likely diminish, at least briefly, his quality of life in return for apossible increase in the quantity of his life. An equally potent factor in this decision, however, is the physicians perception of the efficacy, or lack thereof, of chemotherapy. A consensus that some patients are benefited by chemotherapy for metastatic NSCLC has led to a general recommendation that good performance status (ambulatory) patients receive one to two courses of chemotherapy followed by assessment of response and toxicity (Minna et al., 1989; Mulshine and Ruckdeschel, 1989).Only responding patients with acceptable toxicity continue to receive therapy. This report summarizes some of the evidence in support of such an approach.

DOES A RESPONSE TO CHEMOTHERAPY OFFER ANY SURVIVAL BENEFIT? This is, of course, a fundamental issue. If the answer is no, there would be littlejustificaton for using chemotherapy in this setting. To get a sense of the potential impact of therapy one needs to know the ‘natural history’ of metastatic NSCLC. Several earlier trials of chemotherapy versus BSC demonstrated median survivals ranging from 8-5weeks to 17 weeks for the ‘control’arms (Rapp et al., 1988;Williams et al., 1987;Cormier et al., 1982;Ganz et al., 1989;Woods et al., 1985).The most contemporary trial, the Canadian Multicenter Trial, demonstrated a 17-weekmedian survival for patients receiving BSC only (Rapp et al., 1988). This is strikingly similar to the 16-17 weeks median survival for similar patients who progressed on initial chemotherapy on several Eastern CooperativeOncology Group (ECOG) trials. (Ruckdeschel et al., 1985,1986;Bonomi et al., 1989). Presentedat the symposium on Current Cancer Therapy, H . Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 19 October 1990. *Present address: H. Lee Moffit Cancer Center and Research Institute (at the University of South Florida), P.O. Box 280179, Tampa, FL 33682-0179, U.S.A.

0278-0232/92~010025-06$05.00 0 1992 by John Wiley & Sons, Ltd.

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HEMATOLOGICALONCOLOGY, VOL. 10,2>30 (1992) CHEMOTHERAPY OF METASTATIC NON-SMALL CELL CARCINOMA OF THE LUNG JOHN c. RUCKDESCHEL* Division of Medical O...
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