• H Watanabe and N Saijo.
• Dept. of Internal Medicine, National Cancer Center Hospital.
• Gan To Kagaku Ryoho. 2000 Jan 1; 27 (1): 30-43.

AbstractThere is often little foundation for decisions in experience-based or impression-based medicine. Therapy, however, should be based on the highest level of available evidence. In many clinical cancer practices, "uncertainty" exists. When no evidence is available, it is important that we perform clinical trials to generate new evidence. Organizing multi-institutional clinical trials in Japan is an urgent necessity. Limited disease SCLC Concurrent radiotherapy in combination with cisplatin and etoposide is considered to be a standard treatment in limited disease SCLC. Extensive disease SCLC Chemotherapy regiments such as PE or CAV/PE are standard therapy for ED SCLC. There is no current evidence for alternating chemotherapy, dose intensive chemotherapy, high dose chemotherapy, late intensification chemotherapy or maintenance chemotherapy in extensive disease SCLC. New drugs in combination with cisplatin have been reported to show promising antitumor activity in extensive disease SCLC. The impact of CPT-11 + CDDP on survival may be discussed at the 2000 ASCO meeting. Surgically unresectable stage III NSCLC In a recent meta-analysis, cisplatin-based chemotherapy plus radiotherapy was compared with radiotherapy alone in prolonging survival. Cisplatin-based chemotherapy with or followed by radiation was proven to enhance survival. However, the optimal sequencing of chemotherapy and radiation has not been definitively established. Chemoradiotherapy with new drugs (paclitaxel, docetaxel, vinorelbine, gemicitabine, CPT-11) has been evaluated for activity and efficacy. Metastatic stage IV NSCLC Compared with the best supportive care alone, cisplatin-based chemotherapy yields an absolute improvement in survival. New drugs in combination with cisplatin or carboplatin have been reported to show promising antitumor activity. There is no combination therapy including a new anti-cancer agent which can be recommended as a "gold standard". There is no current evidence that either confirms or refutes non-platinum-based combination chemotherapy. Second line chemotherapy Second line chemotherapy (docetaxel 75 mg/m2) improves survival in patients previously treated with platinum-based chemotherapy.

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