Lung cancer represents the leading cause of
cancer mortality worldwide. Its incidence has declined in men but is increasing in women, assuring that this largely preventable disease will continue to affect millions. In
small cell lung cancer, the advent of
chemotherapy in the 1970s and continued refinements in the 1980s yielded improved median survivals in patients with both limited disease and extensive disease and improved long-term survival in limited-disease patients. Reinduction
chemotherapy was shown in the 1980s to improve survival in patients who had achieved a complete remission to initial
chemotherapy, and a consensus subsequently developed regarding standard
induction chemotherapy for patients with
small cell lung cancer. The prognosis for patients with
small cell lung cancer depends largely on delivering the optimal
combination chemotherapy to achieve early, maximal cell kill with manageable toxicity. Future challenges include comparing newer combinations and novel schedules of administration with "standard"
chemotherapy, optimizing the use of complementary treatment modalities, and refining prognostic factors to better define treatment and improve outcome. In patients with
non-small cell lung cancer, single-modality treatment has been compared with
combined-modality therapy in numerous randomized trials, with consistent survival benefits accrued by patients in combined-modality treatment arms. The recent availability of novel cytotoxic and
cytostatic agents has prompted additional comparisons of new
combination-chemotherapy regimens, with or without other treatment modalities, in patients with
lung cancer. Questions for the future include defining the most effective
chemotherapy to eradicate distant
metastases and understanding which modalities offer superior local control.