Summary Objective This study was conducted to assess the activity and toxicity of gemcitabine in patients with resistant small-cell lung cancer (SCLC) Patients and methods Forty-one patients with limited- or extensive-stage SCLC, who were previously treated with at least one chemotherapeutic regimen and progressed during or within three months of finishing the last regimen, were treated with 1000 mg/m2 gemcitabine on days 1, 8, and 15 of a fourweek cycle. Results Thirty-eight patients were evaluable for response Five partial and no complete responses were seen, for an overall response rate of 13% (95% confidence interval (Cl) 6%-27%) Time to progression varied from 4 to 20 weeks, with a median of 8 weeks Median survival was 17 weeks (range 4-84 weeks) Hematological toxicity mainly consisted of NCI-CTC grade 3 thrombocytopem a (29% of patients) and, to a lesser extent, grade 3 leukopenia (18%) of patients) Non-hematologlcal toxicity was mild, with nausea being the most commonly reported event Conclusions Gemcitabine has modest activity in patients with resistant SCLC There is some non-cross resistance to most agents against SCLC