Neoadjuvant strategies for non-small cell lung cancer

During the last 15-20 years, several phase II trials have investigated the use of chemotherapy and chemoradiation prior to surgery in the management of stage IIIA non-small cell lung cancer (NSCLC). The results of these studies, in contrast to insignificant outcomes of comparative studies with chemotherapy in the postoperative setting, have been encouraging. Moreover, phase III trials comparing surgery alone with chemotherapy plus surgery have confirmed the efficacy of this multimodality approach. In recent years, newer and more effective chemotherapy combinations have become available and are now being used prior to surgery. One focus of ongoing research is to confirm that preoperative chemotherapy followed by complete resection is a better treatment approach than surgery alone, even for patients with early-stage NSCLC. Recent data suggest that induction chemotherapy in this category of patients yields high response rates and does not compromise the outcome of surgery. Given the systemic nature of lung cancer it is estimated that systemic therapy before local treatment will play an increasingly important role for patients with early-stage NSCLC.