Progressive disease

• Worsening clinical signs – see below
• Worsening lab values
• Decreasing functional status
• Evidence of metastatic disease, especially brain

Clinical signs

• Pain, nausea or vomiting
• Dyspnea
• Significant hemoptysis
• Superior vena cava syndrome
• Recurrent pneumonia
• Pericardial effusion/pleural effusion
• Any metastasis

Disease stage

• Stage IV (any T, any N, M1) at initial diagnosis
• Stage III disease with pleural effusion
• A patient with stage III disease who continues to decline in spite of therapy, or refuses therapy
• Performance status Karnofsky score of 70% or less