New agents within the preoperative chemotherapy of non-small cell lung cancer

Surgery alone fails to cure the majority of resected non-small cell lung cancer (NSCLC) patients. Only about half of stage I and II patients remain free of the disease for 5 and more years. The vast majority of stage IIIA patients resected for cure relapse (most of them develop distant spread). A combined modality approach (preoperative cisplatin-based chemotherapy, surgery and radiotherapy) has been shown to increase cure rates in stage IIIA NSCLC from 10-15% to 25-40%. Future improvements, currently under investigation, are expected with the use of chemotherapy prior to surgery in resectable patients with stage IB and II disease. The advent of newer agents, such as paclitaxel, docetaxel, vinorelbine, and gemcitabine have led to the design of potentially more effective preoperative regimens with the ability to advance the cure rate even further. The superiority of new cytotoxic agents incorporated into the preoperative systemic therapy has not been definitely confirmed. This overview presents the current experience with the use of new agents in preoperative chemotherapy for NSCLC.