Chemotherapy for advanced non-small cell lung cancer

Lung cancer is an aggressive disease with poor prognosis after it has advanced. Over the past several years, there has been slow but steady progress in treatment options. Chemotherapy results in a modest improvement in survival, improved quality of life, and decreased pulmonary symptoms. For first-line therapy, platinum-based regimens have generally been the standard of care, with no one regimen clearly superior to the others in terms of overall survival, although there may be differences in response rates, time to progression, toxicities, cost, and schedule. There does not appear to be such a uniform consensus for nonplatinum agents. Triplet regimens are not more effective than doublet regimens and are more toxic and expensive. Chemotherapy should be given for four cycles unless there is unaccepted toxicity or disease progression. Patients with poor PS generally experience increased toxicities and fewer benefits, although this finding needs further investigation to ascertain the appropriate treatment. In second-line setting, docetaxel is the agent that has been extensively studied and approved. Furthermore, molecularly targeted therapy holds a promising future and is discussed in articles elsewhere in this issue.