Neoadjuvant therapy for non-small cell lung cancer

Clinical trials evaluating neoadjuvant or preoperative therapy for locally advanced non-small cell lung cancer (NSCLC) have demonstrated the feasibili ty, tolerability and activity of this approach. Three randomized trials hav e reported improved survival in patients with stage III NSCLC treated with preoperative chemotherapy followed by surgical resection compared to surger y alone. Combinations of neoadjuvant chemotherapy plus thoracic radiotherap y have also been investigated, generally resulting in higher rates of patho logic response, but higher toxicity rates as well. The best approach to neo adjuvant therapy remains to be determined and may well be substage dependen t. In bulky stage III NSCLC, the role of surgery itself remains unclear and is the subject of an ongoing Intergroup trial in the US. Regardless, neoad juvant therapy has emerged as an important paradigm for clinical research s ince it serves as an in vivo test of chemosensitivity in patients, and repr esents a 'window of opportunity' for testing new chemotherapeutic agents an d novel strategies. Among the new chemotherapeutic agents being investigate d in this setting is docetaxel, one of the most active agents in first- and second-line chemotherapy of NSCLC, and a potent radiosensitizer. Prelimina ry studies have confirmed the feasibility of integrating docetaxel into neo adjuvant treatment strategies and encouraging results have been reported. [ (C) 2001 Lippincott Williams & Wilkins].