Chemotherapy of lung cancer

Abstract

Since small-cell bronchial carcinoma must usually be considered a systemic disease, chemotherapy is the predominant form of treatment of this lesion. Polychemotherapy employing two or more cytostatic agents is superior to 'mono-chemotherapy'. Objectively measurable remissions, including 40%-50% complete remission in the limited disease stage, are obtained in between 70% and 90% of the patients. This leads to a median survival rate within the overall group of patients of 12 months. In the case of complete remission, average survival increases to between 15 and 20 months. Five to ten per cent of all patients survive for 2 years and longer, with no recurrent disease, and can be considered to be potentially healed. In the stage of extensive disease, the percentage of complete remission is still 20%, with median survival of 7 to 11 months. In the case of non-small-cell carcinomas, chemotherapy, which is usually administered in the form of polychemotherapy, has only a palliative intent. It leads to remission rates of 25%-45%, including complete remissions in about 5%. A reliable demonstration of the prolongation of life by chemotherapy has, so far, not been provided. For this reason, the establishment of the indication must be particularly strict. The value of adjuvant or neo-adjuvant chemotherapy has, to date, not been demonstrated unequivocally in any clinical study.