Lung cancer was one of the first cancers to be treated with chemotherapy, back in the late 1940s.1 Yet today lung cancer (other than small cell tumours) remains the Cinderella of cancer medicine, left behind as chemotherapy is increasingly used for other neoplasms. Palliative radiotherapy can provide good relief of localised symptoms for patients with inoperable disease.2 Sooner or later, however, most patients develop metastatic disease, and the message they receive remains, “I'm sorry, there's nothing further we can do.” A recent survey of chest physicians, surgeons, and oncologists in Britain showed chemotherapy was offered to only 8% of patients with non-small cell lung cancer and actually given to only 5% (Cancer Research Campaign, data on file, 1991). Is this nihilism justified?

Advanced non-small cell lung cancer certainly lacks the chemosensitivity - sometimes dramatic - of the small cell type, but it is by no means completely resistant to drugs. Response rates of 30-40% are consistently reported with modern chemotherapy regimens,3 and more intensive …