The importance of chemotherapy dose intensity in lung cancer.

The evidence for the importance of maintaining full dose on schedule chemotherapy for lung cancer varies considerably by histologic type. Several studies have evaluated chemotherapy dose and dose intensity in small cell lung cancer; fewer studies have evaluated the importance of chemotherapy in non-small cell lung cancer. The current guidelines of the National Comprehensive Cancer Network recommend adjuvant chemotherapy in most patients with resectable disease, and there is increasing evidence that chemotherapy benefits elderly patients as much as younger patients. Clinical trials in the setting of palliative treatment of advanced non-small cell lung cancer have focused on testing new regimens rather than evaluating the impact of maintaining the dose and schedule of standard chemotherapy regimens. However, in light of the potential curative role of chemotherapy in the adjuvant setting, the optimal doses and schedules of these regimens may have an important impact on outcomes. In addition, data suggest that responses in the neoadjuvant setting correlate with survival, and this may also be an appropriate setting in which to test the effect of the chemotherapy dose and schedule. Survival is the primary measure of treatment efficacy, but other end points, such as quality of life and disease stability, should also be considered in advanced disease. Because new regimens will shape the choice of treatment in the adjuvant and neoadjuvant settings, it is important to determine the significance of maintaining full dose on schedule with conventional chemotherapy regimens to ensure optimal outcomes in the treatment of lung cancer.