Abstract:
Cisplatin continues to play a central role in cancer chemotherapy in spite of its toxicity. It is used as first-line chemotherapy against epithelial malignancies of lung, ovarian, bladder, testicular, head and neck, esophageal, gastric, colon and pancreatic but also as second- and third-line treatment against a number of metastatic malignancies including cancers of the breast, melanoma, prostate, mesothelioma, leiomyosarcomas, malignant gliomas and others. Cisplatin has become the gold standard treatment against cervical cancer in combination with radiotherapy. This review summarizes the state of the art on clinical trials published mainly in 2002 using cisplatin and carboplatin in their combinations with other anticancer drugs. For most advanced cancers the response rate to chemotherapy is about 50% in first-line treatments and about 15% in second- or third-line treatments; for example response rates of 25-50% have been observed for chemonaive patients with advanced non-small cell lung cancer treated with cisplatin or carboplatin in combination with gemcitabine or taxanes and in exceptional cases these rates are up to 80% with addition of radiotherapy. Response rates are very discouraging in second- or third-line chemotherapy treatments (7-25%). Despite an increase in response rate from the use of modern-day chemotherapy drugs, no major difference in long-term survival has been achieved. It is a high priority to invent novel approaches for cancer treatment. It is hoped that a fraction of the numerous experimental drugs will show virtues in the anticancer arena especially combined with existing treatment regimens. Efforts should focus on diminution of side effects improving the quality of life of the patient. A preferential tumor targeting of chemotherapy treatments would bring a revolution in molecular medicine and would greatly advance cancer therapy in the upcoming years.
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