Data obtained from multiple sources indicate that no single mechanism can explain the resistance to chemotherapy exhibited by non-small cell lung carcinomas. The multi-factorial nature of drug resistance implies that the analysis of comprising expression profiles may predict drug resistance with higher accuracy than single gene or protein expression studies. Forty cellular parameters (drug resistance proteins, proliferative, apoptotic, and angiogenic factors, products of proto-oncogenes, and suppressor genes) were evaluated mainly by immunohistochemistry in specimens of primary non-small cell lung carcinoma of 94 patients and compared with the response of the tumours to doxorubicin in vitro. The protein expression profile of nonsmall cell lung carcinoma was determined by hierarchical cluster analysis and clustered image mapping. The cluster analysis revealed three different resistance profiles. The frequency of each profile was different (77, 14 and 9%, respectively). In the most frequent drug resistance profile, the resistance proteins P-glycoprotein/MDR1 (MDR1, ABCB1), thymidylate-synthetase, glutathione-S-transferase-p, metallothionein, O 6 -methylguanine-DNA-methyltransferase and major vault protein/lung resistance-related protein were up-regulated. Microvessel density, the angiogenic factor vascular endothelial growth factor and its receptor FLT1, and ECGF1 as well were down-regulated. In addition, the proliferative factors proliferating cell nuclear antigen and cyclin A were reduced compared to the sensitive non-small cell lung carcinoma. In this resistance profile, FOS was up-regulated and NM23 down-regulated. In the second profile, only three resistance proteins were increased (glutathione-Stransferase-p, O 6 -methylguanine-DNA-methyltransferase, major vault protein/lung resistance-related protein). The angiogenic factors were reduced. In the third profile, only five of the resistance factors were increased (MDR1, thymidylate-synthetase, glutathione-S-transferase-p, O 6 -methylguanine-DNA-methyltransferase, major vault protein/lung resistance-related protein). Lung cancer remains a major cause of morbidity and mortality in Western countries. The majority of bronchogenic carcinomas can be classified into four histological types: small cell lung carcinomas, squamous cell lung carcinomas, adenocarcinomas, and large cell lung carcinomas. Histological features, ultra-structure, clinical course, and response to therapy indicate that small cell lung cancer is a separate entity. The other three histological subtypes are referred to as non-small cell lung cancer (NSCLC). While small cell lung carcinomas are among the most drug sensitive tumours, NSCLC are frequently resistant to drug therapy and obtaining a complete response is rare. Therefore, the drug resistance in patients receiving chemotherapy alone or when combined with radiotherapy represents a major problem in cancer treatment of patients with NSCLC.Data obtained from multiple sources indicate that no single mechanism can explain the resistance to therapy...