Editorial  ||FREE PAPER||

Garry M Walsh

Asthmatic and Allergy Inflammation Group, School of Medicine, University of Aberdeen, UK

This issue of Therapeutics and Clinical Risk Management contains several excellent review articles which focus on diverse disorders. Nonsmall cell lung cancer (NSCLC) is the most common form of the malignancy accounting for 80% of cases. For the most part these patients present with advanced disease for which tumor resection is not an option. Treatment of advanced disease is therefore aimed at improving survival rates. It is important therefore that the associated side effects of treatment do not impact too heavily on the quality of life of patients. Therapy for NSCLC involves chemotherapy with cisplatin or carboplatin in combination with a third-generation cytotoxic drug: vinorelbine, gemcitabine, paclitaxel, or docetaxel. Felip and Rosell (2008) provide a comprehensive review of the clinical utility and toxicity profile of pemetrexed, a multi-targeted antifolate agent, in the treatment of NSCLC. Until recently, docetaxel was the only approved cytotoxic chemotherapy for second-line NSCLC treatment. The authors first reviewed the effectiveness of pemetrexed as a second-line treatment for advanced NSCLC. They concluded that when administered with folic acid and vitamin B12, pemetrexed had comparable efficacy and a superior toxicity profile relative to docetaxel. They also addressed the use of pemetrexed in combination with cisplatin as a first line treatment for NSCLC and report equivalent responses and overall patient survival compared to a combination of cisplatin with gemcitabine. The authors also addressed the potential role of targeted agents in combination with pemetrexed together with the use of pharmacogenomic approaches to predict chemotherapeutic responses in NSCLC patients.