In the 1980s, the introduction of cisplatin (Platinol)-based chemotherapy p
rolonged survival and improved quality of life inpatients with stage III an
d IV non-small-cell lung cancer. More recently, the use of five new chemoth
erapeutic agents-docetaxel (Taxotere), gemcitabine (Gemzar), irinotecan (Ca
mptosar), paclitaxel (Taxol), and vinorelbine (Navelbine)-has further impro
ved treatment results for non-small-cell lung cancer. In advanced disease,
randomized trials have shown that combinations of these agents produce supe
rior results to older cisplatin-based regimens. AL though the new chemother
apeutic agents are more expensive than older drugs, calculations of costs p
er year of life gained have shown them to be cost-effective. The concurrent
use of chemotherapy and chest radiotherapy for stage IIIB disease has prod
uced improvements in survival and quality of life that outweigh increases i
n toxicity. Neoadjuvant chemotherapy plus surgery has improved survival in
patients with stage IIIA disease and mediastinal lymph node involvement, an
d the role of neoadjuvant radiotherapy is being studied in this setting as
well. Finally, trials of neoadjuvant strategies using new-agent combination
s are also being conducted in patients with stage I and II non-small-cell l
ung cancer.