ADJUVANT CHEMOTHERAPY - RESULTS AND PERSPECTIVES

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 L ung Cancer Study Group (LCSG) have shown a modest impact of adjuvant C AP chemotherapy on disease-free and overall survival. In addition, a F innish study, which randomized patients with T1-T3, NO disease to CAP chemotherapy or follow-up, has also demonstrated an improvement in rec urrence-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 NO, T1 N1) showed no benefit, although compliance with treatment was poor. Similarly, adjuvant trials using vindesine and cisplatin have no t demonstrated benefit in studies done in Montreal and New York. Clear ly, 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, oncoge ne mutations and other factors may allow identification of specific su bsets of patients at high risk of recurrence who can be targeted for a ggressive adjuvant approaches in the future.