Novel therapies in lung cancer management. An update on the role of topotecan.

Accessible online at: www.karger.com/journals/ocl Supported by GlaxoSmithKline, Brentford, Middlesex, UK. Lung cancer is far and away the leading cause of cancer-related deaths in the United States. According to recent statistics, 169,500 new cases of lung cancer will be diagnosed in 2001, with an estimated 157,400 deaths [1]. The majority of lung cancer patients present with disseminated (stage III or IV) disease for which they receive etoposideand/or platinum-based chemotherapy. Although etoposideand platinum-based chemotherapy have been associated with high initial antitumor response rates and improved survival and quality-of-life endpoints, such benefits have been modest and short-lived. As a consequence, death from recurrent chemotherapy-resistant metastatic disease remains the inevitable outcome in greater than 90% of patients. The identification of novel agents with activity in first-line and recurrent disease has been an unfulfilled priority for the past 20 years. Although progress in the treatment of lung cancer has been disappointing over the past 20 years, there is now reason for optimism. A number of new cytotoxic agents with novel, nonoverlapping mechanisms of action have been introduced into the clinical armamentarium, including the pyrimidine analogue, gemcitabine; the vinca alkaloid, vinorelbine; the taxanes, paclitaxel and docetaxel; and the topoisomerase I inhibitors, topotecan and irinotecan. The use of these novel agents, with differing cellular targets and resistance profiles relative to standard chemotherapy, has the potential to slow or even prevent the development of resistant cells. Of these active new agents, topotecan (HYCAMTIN®, GlaxoSmithKline, Brentford, Middlesex, UK) is a novel topoisomerase I inhibitor with potentially broad applicability in the treatment of solid and hematologic malignancies, including small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). This special issue of Oncology is devoted to updating the published clinical data related to the use of topotecan in SCLC and NSCLC. The articles presented herein were derived, in part, from presentations delivered at the Ninth World Congress of Lung Cancer in September 2000 in Tokyo, Japan. The World Congress of Lung Cancer, a triannual meeting convened by the world’s leading authorities in the management of lung cancer, is an important venue for disseminating state-of-the-art information pertaining to the use of novel treatments in lung cancer therapy. The role of topotecan in the treatment of lung cancer was an important component of the conference and is the topic featured within this supplement. Articles were contributed by leading experts in the management and treatment of lung cancer from the United States and abroad. This supplement is restricted to the review of cytotoxic agents; therefore, the new molecular-targeted drugs, such as vascular endothelial growth factor or epidermal growth factor inhibitors and antiangiogenesis drugs will not be discussed. The supplement begins with an overview of current standards of care in SCLC and NSCLC (Joan H. Schiller).