Despite recent progress in the development of new molecularly targeted agents, the
chemotherapy regimens considered standard at the end of the last century--that is, two-
drug combinations consisting of either
cisplatin or
carboplatin plus a third-generation agent (
docetaxel,
paclitaxel,
gemcitabine, or
vinorelbine)--remain the primary treatment option for advanced
non-small cell lung cancer (NSCLC) patients. Most recently, the existing standard of care has been amended to reflect the significant survival advantage of
cisplatin-
pemetrexed over
cisplatin-
gemcitabine as first-line treatment of nonsquamous NSCLC. The addition of a
biological drug (
bevacizumab,
cetuximab) or the use of a single-agent
epidermal growth factor receptor inhibitor may further improve outcomes in selected patients. It has become increasingly clear, primarily through recent meta-analyses, that although the therapeutic equivalence of any combination of a
platinum agent plus either
gemcitabine,
vinorelbine,
docetaxel, or
paclitaxel has been long accepted, each regimen has different side effects and therapeutic outcomes that allow clinicians to select the most appropriate treatment for
chemotherapy-naïve patients with stage IIIB/IV NSCLC. In this review, we evaluate the available evidence and explore the role and importance of various modern
chemotherapy regimens, with the aim of optimizing treatment selection and combination with
biological agents. Emphasis is placed on the role of
taxanes (
docetaxel versus
paclitaxel) in this changing landscape.