Gemcitabine (Gemzar)-based induction chemotherapy in non-small-cell lung cancer

The gemcitabine/cisplatin combination is a key regimen in unresectable locally advanced and metastatic non-small-cell lung cancer (NSCLC), and, consequently, it is a logical step forward to investigate the activity of this new combination in less advanced stages of NSCLC. Efficacy data of several phase II studies performed in a mixed study population of stage IIIA and IIIB disease investigating gemcitabine/cisplatin as induction treatment indicate an average response rate > 60%. The treatment is rather well tolerated and toxicity is especially mild when a 3-week schedule is used. More recently, five randomized studies, one already completed, have been designed to investigate the role of induction chemotherapy in early stage (I and II) NSCLC. In Italy, an ongoing randomized clinical trial called Chemotherapy for Early Stages Trial (ChEST) compares the efficacy of surgery alone or surgery plus induction gemcitabine/cisplatin in operable patients (T2-3N0, T1-2N1, T3N1) having progression-free survival as a primary end point.