Emerging chemotherapy agents in lung cancer: nanoparticles therapeutics for non-small cell lung cancer

Since the late 1990s, platinum-based doublet chemotherapy has been the standard of care for treating non-small cell lung cancer (NSCLC) patients without actionable mutations. ECOG 15-94 compared four regimens (cisplatin/gemcitabine, cisplatin/docetaxel, cisplatin/paclitaxel and carboplatin/paclitaxel) among more than 1,200 patients and found equal efficacy, with all four regimens leading to survival rates of 33% at 1 year and 11% at 2 years in advanced NSCLC (stage IIIB-IV) (1). However, these regimens have significant toxicity, and their benefit is limited to patients with good performance status (ECOG 0-1). Patients who are elderly or unfit (ECOG ≥2) have shorter survival and more chemotherapy-related toxicity (2). Often times, these patients are not offered 1st line systemic chemotherapy due to the unfavorable risk-benefit ratio. Another limitation to platinum doublet chemotherapy is its limited efficacy in refractory disease. While targeted therapy [EGFR (3), ALK (4) inhibitors], and immunotherapy [anti-CTLA-4 (5), anti-PD-1 (6,7)], have led to improved survival and response rates in NSCLC, there remain a significant proportion of patients who do not benefit from these strategies, or whom cannot tolerate them