Indications for chemotherapy in stage IV non-small cell lung cancer

Treatment of stage IV NSCLC has been a controversial issue during the last decade. However, there is now clear evidence that cisplatin-containing chem otherapy regimens lead to prolonged survival with an increase of the 1-year survival rates at about 10%. New drugs like gemcitabine, the taxanes (pacl itaxel, docetaxel), and vinorelbine have shown very promising single-agent activity and have been included into modern combination chemotherapy regime ns achieving response rates of 40 to 50%, and 1-year survival rates of betw een 30 and 40%, In comparison to single-agent cisplatin or cisplatin/etopos ide as 'standard treatment approaches', most of these modern combinations c ould demonstrate advantages in terms of response, survival and improved QOL . Patients with favourable prognostic factors are at the moment frequently treated with platinum-based combination chemotherapy often including one of these newer active drugs. Patients with adverse prognostic factors such as elderly or stage IV patients with a reduced performance status are prefera bly treated with single agents such as gemcitabine, paclitaxel or vinorelbi ne. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.