Medical treatment of non-small-cell lung cancer

Palliative chemotherapy alone is an adequate treatment option for patients with non-small-lung cancer (NSCLC) having stage IIIB disease with malignant pleural effusions or stage IV disease if there is a good performance status (WHO 0, 1). Sev-eral combinations of cisplatin, with vindesine, or with vinblas-tine or etoposide, were tested in the 1980s and compared with observation (or best supportive care). Many of these studies, and older studies that did not include cisplatin, were under-powered to detect a reasonably small increase in survival, and because of the substantial toxicity of these cisplatin combi-nations, despite a response rate of 30%, there was broad scepticism about its standard use. In 1995 a large meta-analysis was published that compiled all randomized studies of chemotherapy versus best supportive care in advanced NSCLC [1]. Cisplatin-based trials showed a benefit o