Ifosfamide in the treatment of non-small cell lung cancer

Non-small cell lung cancer (NSCLC) includes squamous, large cell and adenocarcinoma subtypes. It is the leading cause of morbidity and mortality in Poland. Surgery is the treatment of choice in this disease but most cases are diagnosed in stage III (loco-regionally advanced disease) or stage IV (metastatic disease). Therefore combination of radiation and chemotherapy presents the best option for meeting the goals of palliation or prolongation of survival. Metaanalysis indicates that chemotherapy provides a statistically significant benefit over the best supportive care for prolonging survival although the advantage is slight and measured as 6 to 10 weeks. However quality of life during and post chemotherapy cycles was not properly estimated in any of the trials. At best 10-20% of stage IIIB patients may be cured but relapse is common and the median survival remains poor, within the range of 10 to 14 months. Five-year survival following radiation therapy in advanced unresectable lung cancer remains 5-10%. Combination chemotherapy plus radiation may improve these numbers by 2-4%. Cisplatin, ifosfamide, mitomycin C, vinorelbine, paclitaxel, docetaxel, gemcitabine are among drugs with response rates greater than 15%.