Purpose: Current chemotherapeutic regimens have only modest benefit for non-small cell lung cancer (NSCLC) patients. Cumulative toxicities/drug resistance limit chemotherapy given after the first-line regimen. For personalized chemotherapy, clinically relevant NSCLC models are needed for quickly predicting the most effective regimens for therapy with curative intent. In this study, first generation subrenal capsule xenografts of primary NSCLCs were examined for (a) determining responses to conventional chemotherapeutic regimens and (b) selecting regimens most effective for individual patients.Experimental Design: Pieces (1×3×3 mm 3 ) of 32 nontreated, completely resected patients' NSCLCs were grafted under renal capsules of nonobese diabetic/severe combined immunodeficient mice and treated with (A) cisplatin+vinorelbine, (B) cisplatin+docetaxel, (C) cisplatin+gemcitabine, and positive responses (treated tumor area ≤50% of control, P < 0.05) were determined. Clinical outcomes of treated patients were acquired.Results: Xenografts from all NSCLCs were established (engraftment rate, 90%) with the retention of major biological characteristics of the original cancers. The entire process of drug assessment took 8 weeks. Response rates to regimens A, B, and C were 28% (9 of 32), 42% (8 of 19), and 44% (7 of 16), respectively. Certain cancers that were resistant to a particular regimen were sensitive to others. The majority of responsive tumors contained foci of nonresponding cancer cells, indicative of tumor heterogeneity and potential drug resistance. Xenografts from six of seven patients who developed recurrence/metastasis were nonresponsive.Conclusions: Models based on first generation NSCLC subrenal capsule xenografts have been developed, which are suitable for quick assessment (6-8 weeks) of the chemosensitivity of patients' cancers and selection of the most effective regimens. They hold promise for application in personalized chemotherapy of NSCLC patients. Clin Cancer Res; 16(5); 1442-51. ©2010 AACR.Lung cancer is the leading cause of cancer-related mortality worldwide (1). Non-small cell lung cancer (NSCLC) represents over 80% of lung cancer deaths (2, 3). Chemotherapy has been shown to improve the survival of patients with advanced, inoperable NSCLCs or, as adjuvant therapy, to reduce the rate of relapse of patients following resection of early-stage cancers (2, 3). Generally, two-drug combinations of cytotoxic drugs such as gemcitabine, vinorelbine, and docetaxel with cisplatin or carboplatin are used. A recent meta-analysis study showed that platinum-based, adjuvant chemotherapy of patients with resected NSCLCs was associated with a 5% greater 5-year survival rate, revealing marginal effectiveness of current chemotherapeutic regimens (4). Moreover, only a portion of patients who receive first-line treatment can receive further chemotherapy because of rapid disease progression and intolerance to side effects. Additional chemotherapy is particularly limited for patients who have experienced severe toxic...