A Cochrane review included 38 studies with a total of 5 964 subjects. The comparison of chemotherapy versus best supportive care consistently demonstrated a significant benefit in overall survival in favour of the group receiving chemotherapy (HR 0.37, 95% CI 0.24 to 0.55; 3 studies, n=184) corresponding to 11 versus 4.3 months weighted average survival. The comparison of combination versus single-agent chemotherapy provided evidence for a survival benefit in favour of combination chemotherapy (HR 0.82, 95% CI 0.74 to 0.90; 13 studies, n=1914). The price of this benefit was increased toxicity as a result of combination chemotherapy. When comparing 5-FU/cisplatin-containing combination therapy regimens with versus without anthracyclines (HR 0.77, 95% CI 0.62 to 0.95; 3 studies, n=501) and 5-FU/anthracycline-containing combinations with versus without cisplatin (HR 0.82, 95% CI 0.73 to 0.92; 7 studies, n=1147) there was a significant survival benefit for regimens including 5-FU, anthracyclines and cisplatin. Both the comparison of irinotecan versus non-irinotecan (HR 0.86, 95% CI 0.73 to 1.02; 4 studies, n=639) and docetaxel versus non-docetaxel containing regimens (HR 0.93, 95% CI 0.75 to 1.15; 3 studies, n=805) showed non-significant overall survival benefits in favour of the irinotecan and docetaxel-containing regimens.