The care of the lung cancer patient in the 21st century: a new age.
Lung cancer is by far the leading cause of cancer-related death within the United States and throughout the world, with a global incidence estimating 1,240,000 in 2001. While median survival has improved from 7 months in 1960 to 16.8 months in 2001 for all patients diagnosed with lung cancer, much of this progress relates to improved surgical techniques, combined modality therapy for locally advanced disease, improved symptom palliation, and moderate but real improvements in survival of stage IV disease. However, much work remains to be done in a field in which only 15% to 17% of patients live 5 years. The role of chemotherapy in the last decade has expanded substantially, with evidence for extension of median survival in stage IV from 4 months to 8 to 10 months, improvements in symptom control, as well as 1-year survival almost tripling from 11% to 14% to 32% to 37% with modern chemotherapy regimens. Furthermore, progress has also been seen in the use of concomitant chemoradiotherapy, which has become the mainstream approach for treating patients with locally advanced non-small cell lung cancer. Finally, trials with cisplatin-based chemotherapy suggest that for resectable non-small cell lung cancer, improvement in disease-free and overall survival at 5 years is in the range of 4% to 5%. With the development of multiple small molecules and monoclonal antibodies targeting important growth factor receptors, oncogenes and tumor-suppressor genes known to be aberrant in lung cancer, there is hope for further incremental improvements in the treatment of this deadly disease.