Non–Small-Cell Lung Cancer: Then and Now

This is only the second Special Series on lung cancer in Journal of Clinical Oncology (JCO) since its inception 30 years ago, and in the interim, the lung cancer world has certainly changed. In 1983, the major interest was in small-cell lung cancer (SCLC), with hopes that it would become a highly curable disease. Of the eight articles on lung cancer published that first year, five were on SCLC and three were on non–small-cell lung cancer (NSCLC). Compare this to 2011, in which 40 original articles and editorials were published—and only seven involved SCLC. This shows that one cannot always predict the direction or outcome of clinical research, or where the biology will take us. It is always interesting to take a step back to appreciate how far we have come and to define areas that are still in need of improvement. In 1983, defining the role of chemotherapy in lung cancer was the name of the game. Of the eight papers that were published in 1983, five involved clinical trials: two in SCLC and three in NSCLC. The two SCLC trials evaluated the role of etoposide, vincristine, doxorubicin, and cyclophosphamide and high-dose chest radiotherapy, 1 and the same drugs with low-dose, total-body irradiation. 2 The three NSCLC trials investigated the combination of cisplatin and vinblastine 3 ; cyclophosphamide, doxorubicin, and etoposide with or without cisplatin 4 ; and methotrexate, cyclophosphamide, hexamethylmelamine, and lomustine 5 for advanced disease. Needless to say, none of these included