Adjuvant and Induction Chemotherapies in Non-Small-Cell Lung Cancer

Abstract

Many patients with completely resected non-small-cell lung cancer relapse locally or systemically. Besides better local control, therefore, effective systemic therapies are required in order to improve the outcome. Previous adjuvant chemotherapy did result in improved survival in some trials but not in others. A recent meta-analysis of these trials revealed that postoperative cisplatin-based chemotherapy leads to a 13% reduction in the risk of death as compared to surgery alone, which is equivalent to an absolute survival benefit of 5% at 5 years. The availability of new drugs and improved supportive care have resulted in renewed interest in postoperative adjuvant chemotherapy. Thus adjuvant chemotherapy is currently re-evaluated in clinical trials that include more active protocols and better antiemetics in order to improve patient compliance. Many phase II trials of induction chemotherapy with or without radiation therapy suggested an improved clinical outcome in patients with locally advanced non-small-cell lung cancer. More recently, three small randomized trials demonstrated a survival benefit for induction chemotherapy followed by surgery as compared to surgery alone. Thus induction therapy protocols should be further evaluated in clinical trials in order to determine the optimal chemotherapy protocols and the optimal local control (surgery or radiotherapy or both) in patients with locally advanced disease.