In chemotherapy for lung cancer, sometimes less is more.

Chemotherapy remains the backbone of care for patients with metastatic cancer and provides increasing hope for patients and their families as novel drug targets and therapeutic agents are discovered. Over the past decade, the therapeutic arsenal has markedly expanded, from nitrogen mustard and folic acid antagonists of the mid-20th century to the targeted regimens of “personalized” medicine today. In patients with metastatic disease, chemotherapy can slow disease progression, leading to prolonged survival, and palliate symptoms. Lung cancer remains the leading cause of cancer-related mortality in the United States because of both the high prevalence of advanced disease at diagnosis and the low rate of cure of early-stage disease. Thus, many patients with metastatic non–small cell lung cancer (NSCLC) receive chemotherapy with the goal of prolonging life, relieving symptoms, and improving quality of life (QOL).Although chemotherapy can achieve these goals in selected patients with metastatic NSCLC and a good performance status (PS), it has a limited role in patients whose cancer has progressed through multiple lines of therapy and those with a poor PS (eg, ECOG 3 or 4). The response rates for patients with metastatic NSCLC treated with both a platinum and a taxane have been reported to be only 2% for third-line and 0% for fourth-line chemotherapy,