Palliative chemotherapy for non-small cell lung cancer

The results of several randomized trials suggest a marginal survival benefit for patients with metastatic non-small cell lung cancer after treatment with chemotherapy. This intervention, however, has not become standard therapy. Toxicity, cost, and inconvenience have led many physicians to question whether chemotherapy has even a palliative role in this disease. Furthermore, it is well established that patients with a poor performance status, who are most in need of symptomatic palliation, are also those who are least likely to benefit and most likely to experience treatment-related toxicity. Nonetheless, evidence of a symptomatic benefit from combination chemotherapy has been presented. Indeed, symptomatic palliation can result even in the absence of a conventionally defined chemotherapy-induced response. Phase III trials supporting the palliative value of chemotherapy, however, have been limited and inconclusive. Fortunately, other palliative treatment modalities exist. These interventions should be carefully integrated with chemotherapy when an overall treatment plan appropriate for an individual patient is being developed. In addition to the symptomatic needs of each individual, this treatment plan must also address both physician and patient biases.