Treatment of Advanced Lung Cancer

In Brief Lung cancer is the number 1 cancer-cause of death in the United States. The majority of the lung cancer patients are diagnosed with advanced disease. Platinum-based doublet chemotherapy is the standard chemotherapy in the treatment of advanced non–small-cell lung cancer (NSCLC) though non–platinum-based chemotherapy is an alternative possibility. Monoclonal antibodies that inhibit the binding of vascular endothelial growth factors (VEGF), such as bevacizumab, or the epidermal growth factors (EGFR), such as cetuximab, have been shown to significantly prolonged overall survival (OS) in combination with platinum-based doublet chemotherapy in the first line treatment of NSCLC. The optimal number of cycles of first line chemotherapy is between 3 and 4. Maintenance therapy with noncross-resistant agents after first line treatment is still considered as investigational at this time. The oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI),erlotinib, has been approved for use as second line or beyond in the treatment of NSCLC based on superior survival benefit over best supportive care. NSCLC patients with EGFR activation mutations generally had better response to erlotinib and are generally found in Asian, never-smokers, females, and adenocarcinoma histology. Studies have shown that lung cancer in never-smokers is a clinical entity and had superior overall survival. Studies are underway to determine which patients will benefit from platinum-based chemotherapy. Randomized trials have shown that elderly patients or patients with performance status (PS) 2 also benefited from chemotherapy. Review of the latest medical oncology treatment for patients with advanced non–small-cell lung cancer.