Platinum-based chemotherapy for advanced non-small-cell lung cancer

Summary: Platinum compounds provide the foundation for the treatment of patients with advanced NSCLC. Treatments with such regimens offer patients with an improvement in good performance status, in quality of life and prolonged survival, compared to BSC. Carboplatin very likely offers similar efficacy outcomes compared to cisplatin in this setting, and with less toxicity. Treatment with a platinum-based doublet incorporating a newer, third-generation cytotoxic agent is the recommended therapy for good-performance-status patients with advanced NSCLC, yielding an approximate response rate of 30%, median survival of 8-12 months, 1-year survival of 30%, and 2-year survival of 10%. No single regimen is recommended as superior; selection of the regimen can be flexible, contingent upon the patient's comorbidities, treatment cost, and administration schedule. Adding a third cytotoxic agent is only likely to exacerbate toxicity, without improving efficacy. Treatment should be limited to four cycles in patients with stable disease, and possibly a maximum of six cycles, as tolerated, in responding patients. Age alone should not preclude consideration for treatment with a platinum doublet, although prospective data using platinum agents in studies restricted to elderly patients are lacking. Finally, research continues into the identification of platinum-sensitive patients based upon pharmacoge-nomic parameters, and the development of newer platinum compounds.