Optimal chemotherapy in advanced non-small-cell lung cancer

In inoperable advanced non-small-cell lung cancer (NSCLC), palliative chemotherapy relieves symptoms, improves quality of life and increases the 1-year survival rate by absolute 10%. Its outcome, however, is affected by tumor stage, performance status, weight loss and possibly other factors (1). Patients with good performance status and adequate organ function should receive first-Line chemotherapy with platin-based protocols that include new drugs (vinorelbine, gemcitabine, paclitaxel, or docetaxel). New drugs without platins are suitable for elderly patients and might also be considered for patients with poor performance status. Second-line chemotherapy is indicated in patients with good performance status and primarily aims at palliation of symptoms. Finally, it should be stressed that participation in clinical trials remains the treatment of choice for patients with advanced NSCLC.