[Neo-adjuvant chemotherapy of non-small cell bronchial cancers (NSCLC)]

TO PROLONG SURVIVAL: Systemic neo-adjuvant chemotherapy attempts to reduce the development of metastases. Data available on neoadjuvant chemotherapy of NSCLC come from three types of clinical trials. NEO-ADJUVANT CHEMOTHERAPY PHASE II TRIALS: Many trials have demonstrated that the neo-adjuvant approach is feasible, that it leads to a high rate of response, to the order of 50 to 70%, that it does not compromise surgery, and exhibits acceptable toxicity. High survival rates have been obtained, notably in total responders. NEO-ADJUVANT CHEMO-RADIOTHERAPY PHASE II TRIALS: Have essentially demonstrated that this approach is feasible, exhibits acceptable toxicity, worse in pneumonectomy. High response rates have been obtained and relative improved survival, since most of the cases concerned extensive forms that could not be treated surgically. RANDOMIZED PHASE III TRIALS: Gave varying results: two of them only concerned small series of patients (60 in all) with stage IIIA NSCB, with positive results. The third study concerned 373 patients with stage I, II and IIIA cancers: survival at 3 years was increased by 11%, but this difference is not yet significant. Benefits were essentially apparent for stage I and II patients.

Continued active clinical research, oriented differently, on stage I and II, and stage IIIA is necessary.