Two- versus three-drug combinations in the chemotherapy of advanced non-small-cell lung cancer

Palliative chemotherapy with three-drug combinations might result in higher efficacy but also enhanced toxicity when compared with two-drug combinations. Italian trials suggested the superiority of cisplatin/gemcitabine/vinorelbine and cisplatin/gemcitabine/paclitaxel over corresponding two-drug combinations. However, a Spanish trial failed to demonstrate an advantage of cisplatin/gemcitabine/vinorelbine over cisplatin/gemcitabine and another multicenter phase III trial did not find differences in response rates and survival between cisplatin/vinorelbine/ifosfamide and cisplatin/vinorelbine. Thus three-drug combinations have not convincingly been demonstrated to be superior to two-drug combinations and should not be considered as standard protocols in advanced NSCLC.