Chemotherapy for advanced non-small-cell lung cancer: who, what, when, why?

Despite the poor survival of patients with advanced (stage IIIB with pleural effusion or stage IV) non-small-cell lung cancer, the introduction of new chemotherapeutic agents has improved survival and quality of life with reduced toxicity compared with older cisplatin-based therapies. Randomized trials support the use of two-drug combinations for patients of all ages with performance status of 0 to 1. These two-drug combinations should contain at least one new agent. Some of these two-drug combinations may be acceptable in selected patients with a performance status of 2. Newer, targeted therapies hold promise to improve outcome without adding a great deal of additional toxicity.