Neoadjuvant cisplatin chemotherapy before chemoradiation: a flawed paradigm?

Area of Science:

• Oncology
• Medical Research

Background:

• Chemotherapy (CT) revolutionized solid tumor treatment with anthracyclines and platinum agents.
• Neoadjuvant CT (NACT) emerged as a strategy before local treatment (surgery or RT).
• NACT response was considered a prognostic indicator for RT/chemoradiotherapy (CRT).

Purpose of the Study:

• To debate the efficacy of NACT in reducing metastases and improving local control.
• To evaluate NACT's role in selecting patients for non-surgical treatment.
• To assess NACT's impact on disease-free survival (DFS) and overall survival (OS) across various solid tumors.

Main Methods:

• Review of existing evidence on NACT in head and neck, esophagus, cervix, anus, nasopharynx, bladder, and non-small-cell lung cancer.
• Analysis of NACT outcomes when preceding RT, CRT, or surgery.
• Comparison of taxane-based regimens versus cisplatin-based NACT.

Main Results:

• NACT before RT or CRT has consistently failed to improve DFS or OS in solid tumors.
• NACT shows stronger evidence for improving DFS/OS when administered before surgical resection.
• Taxane-containing regimens show promise but haven't improved concurrent CRT outcomes.

Conclusions:

• NACT is generally ineffective in improving survival outcomes when preceding RT or CRT.
• The primary benefit of NACT appears to be in the neoadjuvant setting before surgery.
• Further meta-analyses are needed to compare induction CT followed by RT/CRT versus RT/CRT alone.