title: First-line systemic chemotherapy in the treatment of advanced non-small cell lung cancer: a systematic review.
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) frequently presents at an incurable stage, and a majority of patients will be considered for palliative chemotherapy at some point in their disease. This article reviews the growing evidence for first-line treatment in NSCLC.
  
  
  METHODS
  Studies of first-line chemotherapy regimens including new agents (docetaxel, gemcitabine, irinotecan, paclitaxel, pemetrexed, and vinorelbine) and targeted agents (bevacizumab, erlotinib, and gefitinib) were identified through Medline, Embase, the Cochrane databases, and web sites of guideline organizations.
  
  
  RESULTS
  Two evidence-based guidelines, 10 systematic reviews, and forty-six randomized trials were eligible for inclusion. Randomized studies suggest that platinum-based doublets (platinum plus new agent) are the standard of care for first-line systemic therapy. No one new agent is clearly superior for use in combination with a platinum agent. The survival advantage of platinum-based doublets over nonplatinum combinations or older combinations is modest. The addition of bevacizumab to carboplatin and paclitaxel has shown improved survival, although multiple exclusion criteria limit the applicability of these data to a subset of patients. In patients at least 70 years of age or with Eastern Collaborative Oncology Group performance status 2, a new single agent is an alternative. Treatment beyond four to six cycles impedes quality of life without prolonging life. Emerging data suggest that the choice of chemotherapy agent may be influenced by histologic subtype.
  
  
  CONCLUSIONS
  In NSCLC, a combination of a platinum agent plus a new agent continues to be the standard of care. As differences between regimens are small, toxicity and patient preference should help guide regimen choice.
authors.affiliation: Juravinski Cancer Centre at Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada. John.Goffin@jcc.hhsc.ca
authors.forename: John
authors.initials: J
authors.lastname: Goffin
authors.forename: Christina
authors.initials: C
authors.lastname: Lacchetti
authors.forename: Peter M
authors.initials: PM
authors.lastname: Ellis
authors.forename: Yee C
authors.initials: YC
authors.lastname: Ung
authors.forename: William K
authors.initials: WK
authors.lastname: Evans
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
chemical_list: D016190:Carboplatin; D002945:Cisplatin