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 chemotherapy, have improved response rates, although they have not been shown to significantly impact survival among patients with completely resected stage I and II NSCLC. Future improvements in NSCLC therapy, currently under investigation, are likely to come from newer agents shown to be active in this disease and from alternative schedules, such as neoadjuvant or concurrent combined modality treatments. Neoadjuvant cisplatin-based chemotherapy has 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, and gemcitabine, may be able to advance the cure rate even further. Radiotherapy, which has been shown to decrease the rate of local recurrence, may play a role as well.