Multi-drug cytotoxic chemotherapy for small cell lung cancer has a high level of toxicity, and not all clinicians consider that its immediate use is justified. A total of 156 patients in a multi-centre study were therefore allocated at random to ECMV (etoposide, cyclophosphamide, methotrexate and vincristine) or ST (selective treatment, in which radiotherapy and/or single drug chemotherapy with cyclophosphamide were given as required to relieve symptoms). In the ECMV series compared with the ST series, survival was prolonged (p<0.0001, log-rank test), median survivals being 33 and 17 weeks, but reported adverse reactions (ignoring alopecia) were commoner (77% vs 35%). The commonest reactions were vomiting (37% vs 10%) and haematological reactions (33% vs 10%), the latter predominantly leucopenia (23% vs 8%), defined as WBC < 3000/mm3. Peripheral neuropathy occurred in 8% of the ECMV but in none of the ST patients. Quality of life was assessed using a diary card completed daily by the patient. Compliance in its use varied greatly from centre to centre. During the first 12 weeks, vomiting on one or more occasions was reported in 6% of patient-days in the ECMV compared with 2% in the ST series. Level of activity was normal for 27% and 36% of patient-days respectively. Differences between the two series with respect to mood, degree of anxiety, and general condition were small.