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Evolution of Cisplatin-Based Chemotherapy in Non-Small Cell Lung Cancer^*

A Historical Perspective and The Eastern Cooperative Oncology Group Experience

^* From the Division of Medical Oncology, Vanderbilt University School of Medicine, Nashville, TN.

Correspondence to: David H. Johnson, MD, Division of Medical Oncology, 1956 The Vanderbilt Clinic, Nashville, TN 37232-5536; e-mail: david.johnson{at}vanderbilt.edu

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in most industrialized nations, including the United States. Frequently, patients with unresectable disease are treated with symptomatic care alone or, in the case of locally advanced, unresectable lesions, with radiotherapy alone. In general, chemotherapy is viewed as ineffective, and therefore rarely recommended except by medical oncologists. Over the past 2 decades, however, it has become clear that chemotherapy, and in particular cisplatin-based chemotherapy, provides a modest survival advantage. In addition, recent studies indicate that chemotherapy can improve tumor-related symptoms and quality of life. With modern chemotherapy, median survival averages around 9 to 10 months in advanced NSCLC, a figure comparable to that achieved with treatment of extensive-stage small cell lung cancer, a malignancy generally viewed as chemotherapy sensitive. Importantly, existing data indicate that chemotherapy is also cost-effective. Given these observations, it is appropriate today for patients with advanced NSCLC to receive chemotherapy.

Key Words: carboplatin • cisplatin • combination chemotherapy • non-small cell lung cancer • performance status • survival

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