Chemotherapy versus palliative care in non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is the world's leading cause of cancer death and about 75% of all patients have advanced disease incurable with localized treatments (surgery and radiotherapy) alone. The aims of therapy in these are palliation of symptoms and extension of life. A substantial body of evidence has emerged in the last 15 years which shows that cisplatin-based combination chemotherapy prolongs life in advanced NSCLC. This evidence, which was well summarized in a major meta-analysis published in 1995, indicated that the degree of impact on survival is modest. Hence the balance between survival benefit and treatment-related toxicity is crucial in all considerations of chemotherapy in this disease. More recently this balance has been altered by considerable progress in the reduction of treatment-related toxicity and by documentation of lung cancer symptom palliation by effective chemotherapy. In 1999 a randomized trial of mitomycin, ifosfamide and cisplatin versus palliative care in 351 patients demonstrated a significant survival advantage for those receiving chemotherapy, which did not compromise their quality of life. This review looks forward to further progress employing newer agents both as first- and second-line chemotherapy in advanced NSCLC.