Treatment Strategies

Advanced disease (stage IV)

Stage IV NSCLC is characterised by extensive metastases and, as with other metastatic cancers, it is considered incurable with 5-year survival rates of approximately 5% at best. Surgery is not considered to be a curative treatment in this setting, but it may be used for the palliation of acute discomfort or symptoms. Similarly, radiotherapy or chemoradiotherapy are not employed routinely in the treatment of late-stage disease. Chemotherapy, notably cisplatin-based therapy, palliates symptoms and has been shown to prolong survival in stage IV NSCLC. Although cisplatin can elicit a response in approximately 20% of patients with advanced NSCLC as a single agent, in the 1980s it became established as the essential component for combination therapies that included etoposide, vinblastine and vindesine.

More recently, the third-generation agents such as the camptothecins, gemcitabine and the taxanes have been introduced into the mainstream therapy strategies for advanced NSCLC. Response rates have been reported in the region of 20% and median survival can be as high as 22 weeks.¹

A significant proportion of patients may have developed stage IV NSCLC after treatment-failure for early-stage disease. Typically, such patients have a substantial treatment history that may include surgery or radiotherapy, and in addition they may have been exposed to numerous standard drugs. Acquired drug resistance is a major issue in these patients and their prognosis is very poor. Heavily pre-treated patients who have reasonable PS, are often asked to participate in phase I and II trials for new innovative drugs that have shown promising results in preclinical studies.

Treatment Strategies

• Overview
• Early Stage
• Locally Advanced Stage
• Advanced Stage
  • Quality of Life
• Future Strategies