Preoperative chemotherapy for non-small cell lung cancer

Surgery has been considered the standard of care in patients with early-sta ge non-small cell lung cancer (NSCLC). as well as in some cases of stage II I Cor a long time. Poor survival after complete resection has led to the se arch for new therapeu tie strategies such as combining anticancer treatment s. However: at the present time, attempts to combine chemotherapy and radio therapy after surgery have failed to show any significant impact on surviva l among patients with completely resected NSCLC. Preoperative chemotherapy may give superior results to postoperative system ic treatment. In stage IIIA NSCLC, phase ii studies have shown the feasibil ity and efficacy of this approach with response rates higher than that obse rved in more advanced disease. Chemotherapy alone and its combination with radiotherapy have been tested. The most recent trials have demonstrated the feasibility of concomitant chemoradiotherapy in stage IIIA NSCLC. Three small randomized trials have been published in stage IIIA NSCLC. They argue strongly in favour of preoperative chemo-therapy with a significant improvement in overall survival. A large french study included over 350 pat ients. A multivariate analysis using a Cox model showed a decreased relativ e risk of death in the preoperative chemo-therapy arm in stage \B, II and I IIA. Newer active agents such as paclitaxel, gemcitabine, vinorelbine and doceta xel may play a role in the improvement of lung cancer survival when used pr eoperatively. It is essential that clinical investigators collaborate in la rge clinical trials. (C) 2001 Harcourt Publishers Ltd.