Chemotherapy in resectable non-small cell lung cancer

Abstract

Although radical surgery is the primary treatment for early non-small cell lung cancer (NSCLC), the longterm survival of patients who undergo surgery alone is largely disappointing. More than half of those patients who present with stage I-IIIA disease and are resected will experience distant relapse. Postoperative adjuvant chemotherapy has been evaluated in several randomized trials but the results of these trials have been inconclusive with increased survival reported in few trials. However, the largest randomized adjuvant study presented to date, reported a 4.1% improvement in survival at 5 years, a benefit comparable to that observed using adjuvant chemotherapy in breast and colon cancer. A meta-analysis of new generation adjuvant trials is planned, it will include over 4,000 patients and will be of major relevance in this field. In resectable stage IIIA NSCLC the findings of randomized trials have indicated that the survival of these patients is better with neoadjuvant chemotherapy plus surgical resection than with resection alone. Phase II trials using preoperative concurrent chemoradiotherapy have been carried out with encouraging results. The majority of patients with stage IIIA NSCLC require multimodality therapy if they are to achieve a 5-year survival. Combined modality treatment in NSCLC continues to evolve and is a subject of ongoing research. Some data suggest that induction chemotherapy in stage I-II is feasible, does not appear to compromise surgery and yields high response rates. Neoadjuvant chemotherapy is potentially useful not only in locally advanced disease, but also in patients with earlier disease.