Adjuvant chemotherapy: results and perspectives

Abstract

The overall 5-year survival of surgically resected non-small cell lung cancer (NSCLC) remains less than 50% and is unlikely to improve until there are effective systemic adjuvant therapies. Two studies of the Lung Cancer Study Group (LCSG) have shown a modest impact of adjuvant CAP chemotherapy on disease-free and overall survival. In addition, a Finnish study, which randomized patients with T1-T3, NO disease to CAP chemotherapy or follow-up, has also demonstrated an improvement in recurrence-free survival, as well as overall survival, at 5 and 10 years. On the other hand, an LCSG trial of adjuvant CAP in Stage I NSCLC (T2 N0, T1 N1) showed no benefit, although compliance with treatment was poor. Similarly, adjuvant trials using vindesine and cisplatin have not demonstrated benefit in studies done in Montreal and New York. Clearly, more effective systemic therapy is needed and must be evaluated in randomized trials in which patients have been carefully staged intra-operatively. Biological markers, such as vascular invasiveness, oncogene mutations and other factors may allow identification of specific subsets of patients at high risk of recurrence who can be targeted for aggressive adjuvant approaches in the future.