Lung cancer



Experience has shown that the drugs which have served so well in the treatment of small cell lung cancer, such as the alkylating agents, have actually had an adverse effect on survival in non-small cell cancer. It is only recently that the possibility of effective chemotherapy has emerged (Meta-analysis by NSCLC Collaborative Group 52 trials, 9387 patients BMJ Vol 311;899-909, Oct 7 1995). The regimes which have shown the most response have been those containing Cisplatin particularly in combination with one or two other effective drugs. The MIC (Mitomycin C, Ifosfamide, Cisplatin) and MVP (Mitomycin C, Vinblastine, Cisplatin) have shown response rates in the vicinity of 50% with acceptable toxicity. The effects, while being very useful in terms of palliation, have not translated into long term survival. Newer drugs such as paclitaxel, doxetaxel, gemcitabine and vinorelbine have all shown responses as single agents and trials are ongoing to determine the most effective combinations.

One area where chemotherapy has made significant differences to survival has been in relatively early but locally advanced unresectable disease. Downstaging of these tumours by induction chemotherapy has been shown to increase the resectability rate and the associated survival. Similarly, when used in conjunction with radical radiotherapy, an increase in survival has been achieved. Such multi-modality therapies have a higher treatment related mortality than the individual therapies. Radiotherapy associated with surgery can lead to an increase in the incidence of pneumonitis and broncho-pleural fistula. Similarly some chemotherapeutic agents, in addition to their bone marrow suppressive effects which make sepsis, haemorrhage and anaemia more likely after surgery, have a direct effect on lung tissue increasing the incidence of pneumonitis and Acquired Respiratory Distress Syndrome (ARDS). Judicious use of preoperative blood product transfusion, intra-operative fluids and postoperative steroids can keep such complications to a minimum.