Chemotherapy for stage IV non-small cell lung cancer

Chemotherapy regimens with consistent activities in NSCLC have been identified. A modest but statistically significant increase in survival has been shown in a single large randomized trial, with three smaller trials showing either similar results or a trend toward an improved survival. However, chemotherapy-related toxicity remains significant and seems exacerbated in patients with a poor performance status at the time of diagnosis. Identification of chemotherapy regimens with higher activity in NSCLC remains a necessity, and the treatment of stage IV patients on clinical trials should be encouraged. Outside the context of a clinical trial, chemotherapy is indicated in selected stage IV patients with good performance status in an attempt to palliate their symptoms and increase their survival.