Chemotherapy in advanced non-small-cell lung cancer: a look behind and ahead

Lung cancer is still the leading cause of cancer-related deaths in Western countries. The 5-year survival rate in 2002 remains dismal. In advanced disease, chemotherapy is the cornerstone of treatment, but a crucial step is whether the impact of chemotherapy in the management of this disease justifies either the toxicity on patients or the always-rising costs. A number of randomized trials demonstrated a prolonged survival for patients treated with chemotherapy compared with best supportive care. However, newer platinum-based combination regimens have failed to take a major step forward; chemotherapy alone has reached a plateau of activity that could be partially solved by integrating molecular-targeted strategies in clinical practice. Quality of life remains a key issue in clinical decisions for metastatic patients. New answers will come by encouraging all fit patients to join clinical trials.