The major lesson for pulmonologists from this article is that second-line (and even third- and fourth-line) therapy for metastatic non-small cell lung cancer is common and reasonable for patients who remain in “good” condition and who desire further treatment.5–7 This is an important change in clinical perspective. A decade ago, there were essentially no active regimens for patients who failed first-line chemotherapy. Indeed, up to the mid 1990s, the response rate for first-line chemotherapy was only on the order of 20 to 25%, and only 25% of patients with metastatic disease survived > 1 year.8Following the introduction of the taxanes, gemcitabine and navelbine, in the mid-1990s, the response rates have climbed and 1-year survival is closer to 50%, with 20 to 30% of patients with metastatic disease surviving ≥ 2 years.9–10 The later introduction of the epidermal growth factor receptor (EGFR)-targeted agents, gefitinib and erlotinib,11has added another level of response and disease control that has served to prolong survival in the second-line setting. Most recently the addition of bevacizumab, an angiogenesis inhibitor, to paclitaxel plus carboplatin resulted in a significant improvement in survival, although there is a small subset of patients with severe and even fatal hemorrhage.12 When I first joined the American College of Chest Physicians in 1993, there were still debates about whether patients should receive any chemotherapy for metastatic lung cancer. We are, thankfully, well beyond those discussions as demonstrated by the appearance of this article in CHEST (see page 1031).