Adjuvant and neoadjuvant chemotherapy for non-small cell lung cancer - A time for reassessment?

Surgical resection has limited success in curing non-small cell lung cancer (NSCLC), particularly among patients with locally advanced disease (stage IIIA). Combined modality regimens, utilizing surgery, radiotherapy, and che motherapy, have improved response rates, although they have not been shown to significantly impact survival among patients with completely resected st age I and II NSCLC. Future improvements in NSCLC therapy, currently under i nvestigation, are likely to come from newer agents shown to be active in th is disease and from alternative schedules, such as neoadjuvant or concurren t combined modality treatments. Neoadjuvant cisplatin-based chemotherapy ha s already been shown to increase cure rates in stage IIIA NSCLC, from 10 to 15% to 25 to 30%. Newer active agents, such as paclitaxel, vinorelbine, an d gemcitabine, may be able to advance the cure rate even further. Radiother apy, which has been shown to decrease the rate of local recurrence, may pla y a role as well.