Platinum Compounds in Lung Cancer: Current Status

Abstract

Randomized clinical studies and meta-analyses of the literature have confirmed the improved survival of platinum-based chemotherapy doublets, that are considered standard therapy in patients with advanced non-small cell lung cancer (NSCLC) with a good performance status. The use of platinum compounds have also demonstrated a slight survival advantage over nonplatinum-based chemotherapy. Cisplatin remains the platinum agent of choice in the management of patients with NSCLC in both the advanced and adjuvant setting based on the results from recent meta-analyses. However, carboplatin may be offered to patients in advanced stages of the disease due to its more favorable toxicity profile. To date, four targeted agents (bevacizumab, cetuximab, erlotinib and gefitinib) have been studied in combination with platinum-based chemotherapy in the treatment of advanced NSCLC. Only bevacizumab has been shown to significantly prolong survival when added to carboplatin/paclitaxel as demonstrated in a large phase III study. However, issues of toxicity limit this treatment regimen to selected patients. The combination of bevacizumab with cisplatin and gemcitabine appears promising but is still awaiting the final results of the unpublished survival data. Preliminary studies indicate that molecular tumor markers may be able to identify tumors that are more likely to respond to chemotherapy. Excision repair cross-complementation group 1 (ERCC1) and Ribonucleotide Reductase MI (RRMI) are two such genes critical to DNA synthesis and DNA damage repair pathways that have been studied. The results from the first prospective phase III randomized trial suggest that customizing chemotherapy based on ERCC1 expression in patients with advanced NSCLC is a feasible approach. In the future, selection of patients based on pharmacogenetics may help identify patients who will optimally benefit from specific therapies.