Neoadjuvant chemotherapy in non small cell lung cancer—the UK experience

Abstract

I would like to present a surgeon’s view of neoadjuvant chemotherapy and our experience in the United Kingdom. The problem for lung cancer surgeons is that no matter how successful and satisfying the operation, more than 50% of the patients will develop recurrent tumour [1]. It is therefore only a foolish surgeon who thinks that surgery alone is adequate treatment. Surgeons should be prepared to work closely with oncologists and facilitate multimodality treatment. Preoperative chemotherapy may improve postoperative survival rates by treating micrometastases at the start of treatment or by controlling the growth of residual tumour stimulated by the release of growth factors released by surgery and the subsequent healing process. In my practice in the UK we enter patients into the EORTC-08941 trial for neoadjuvant treatment in histologically proven stage IIIa NSCLC and use the Big Lung Trial to enter patients for neoadjuvant or adjuvant chemotherapy for stage I or II or resected stage IIIa disease. We are considering the Medical Research Council (MRC) LU 22 trial for neoadjuvant chemotherapy for ‘otherwise resectable’ non-small cell lung cancer (NSCLC).