Chemotherapy for stage IV non-small cell lung cancer: Protocol versus nonprotocol? Is noninvestigational treatment worthwhile? Patient selection? Which regimen? What's next?

The results of selected chemotherapy trials and philosophical considerations regarding the role of chemotherapy in Non-Small Cell Lung Cancer are discussed in this review. The issue of treating patients within a clinical or with a 'standard regimen' is addressed. In addition, the survival results of randomized trials in which chemotherapy was compared with supportive care and the related quality of life and economic concerns are reviewed. Physicians' attitudes regarding treating advanced non-small cell lung cancer patients as well as the questions of patient selection and the choice of regimen including the consideration of single versus combination regimens are discussed. The results of single agent phase II trials that identified new agents with response rates ≥15%-paclitaxel, docetaxel, vinorelbine, gemcitabine, CPT11-are described, and their implications for the design of new clinical trials are discussed.