Future scenarios for the treatment of advanced non-small cell lung cancer: focus on taxane-containing regimens

Abstract

Despite recent progress in the development of new molecularly targeted agents, the chemotherapy regimens considered standard at the end of the last century--that is, two-drug combinations consisting of either cisplatin or carboplatin plus a third-generation agent (docetaxel, paclitaxel, gemcitabine, or vinorelbine)--remain the primary treatment option for advanced non-small cell lung cancer (NSCLC) patients. Most recently, the existing standard of care has been amended to reflect the significant survival advantage of cisplatin-pemetrexed over cisplatin-gemcitabine as first-line treatment of nonsquamous NSCLC. The addition of a biological drug (bevacizumab, cetuximab) or the use of a single-agent epidermal growth factor receptor inhibitor may further improve outcomes in selected patients. It has become increasingly clear, primarily through recent meta-analyses, that although the therapeutic equivalence of any combination of a platinum agent plus either gemcitabine, vinorelbine, docetaxel, or paclitaxel has been long accepted, each regimen has different side effects and therapeutic outcomes that allow clinicians to select the most appropriate treatment for chemotherapy-naïve patients with stage IIIB/IV NSCLC. In this review, we evaluate the available evidence and explore the role and importance of various modern chemotherapy regimens, with the aim of optimizing treatment selection and combination with biological agents. Emphasis is placed on the role of taxanes (docetaxel versus paclitaxel) in this changing landscape.

Figure 1.

A possible decision algorithm for the first-, second-, and third-line treatment of “fit” patients with advanced non-small cell lung cancer (NSCLC). ^#At present, pemetrexed may be used for maintenance treatment of patients with advanced nonsquamous NSCLC whose disease has not progressed after four cycles of a pemetrexed-free platinum doublet. Maintenance erlotinib may be an option in all advanced NSCLC patients with stable disease after four cycles of platinum-based chemotherapy. ^§In selected cases. ^°Preferably in tumors harboring EGFR mutations. Abbreviations: Beva, bevacizumab; CBDCA, carboplatin; CDDP, cisplatin; EGFR-TKIs, epidermal growth factor receptor tyrosine kinase inhibitors; Gem, gemcitabine; NOS, not otherwise specified; Pem, pemetrexed; PTX, paclitaxel; TXT, docetaxel.