Management Issues for Stage IV Non-Small-Cell Lung Cancer

BACKGROUND:The management of stage IV non-small-cell lung cancer (NSCLC) has been a controversial subject over the past several decades. Data from randomized trials and from phase II trials on new cancer agents are changing physician attitudes and treatment practices. METHODS: The literature on the management of metastatic lung cancer was reviewed and interpreted. RESULTS: There is good evidence from randomized controlled trials and meta-analyses that chemotherapy provides a modest survival benefit in stage IV NSCLC. There is indirect evidence of improvement in quality of life, as systemic chemotherapy palliates cancer-related symptoms in the majority of patients. New drug combinations are likely to improve recent treatment results with less morbidity than older chemotherapy regimens. Despite the relatively high cost of these treatments, chemotherapy is cost effective in the Canadian health care environment relative to other accepted medical interventions. CONCLUSIONS: Chemotherapy will play an increasing role in the management of patients with advanced NSCLC.