Response to chemotherapy, quality of life benefits and survival in advanced non-small cell lung cancer: review of literature results.

The survival benefit obtained with chemotherapy administration in advanced non-small cell lung cancer (NSCLC) patients has been demonstrated by numerous meta-analyses published between 1993 and 1999 on randomised trials comparing best supportive care with or without chemotherapy. However, some clinicians are still reluctant to prescribe chemotherapy in these patients, arguing that the benefit is too small to counterbalance the side effects. The goal of this paper is to review the reasons favouring the administration of chemotherapy. First, there is a demonstrated relationship between response to chemotherapy and survival, although more data are needed to assess response to chemotherapy as a surrogate for survival. Secondly, recent randomised trials comparing best supportive care to chemotherapy, but not included in the meta-analyses, have successfully incorporated quality of life (QoL) as an endpoint, sometimes as a primary endpoint. The survival benefit shown by the meta-analyses is confirmed by these latter trials; in addition, the QoL assessments, despite some methodological problems inherent to attrition in these poor prognosis patients, also favour chemotherapy with regard to some global aspects, such as physical, functioning, emotional, cognitive or social components, as well as some lung cancer symptoms. We conclude that there are no longer convincing arguments against chemotherapy administration in patients with advanced NSCLC, at least in patients eligible for inclusion in clinical trials.