Adjuvant therapy in non-small cell lung cancer: future treatment prospects and paradigms

There is a high risk of relapse after curative-intent resection for even early-stage non-small cell lung cancer (NSCLC), and thus adjuvant chemotherapy has been explored with the goal of eliminating occult metastases and consequently reducing the risk of recurrence. Although adjuvant chemotherapy confers a survival advantage of approximately 5% at 5 years and is now generally accepted for patients with stage II-IIIA disease, adjuvant therapy for patients with stage I disease is more controversial. In this review we describe approaches to improve treatment outcomes and ongoing research into new therapies in the adjuvant setting. In the future it is likely that patient selection on the basis of gene signatures and biomarkers will be of increasing importance in determining optimal treatment for individual patients. New targeted therapies such as epidermal growth factor receptor (EGFR) inhibitors, angiogenesis inhibitors, and anticancer immunotherapies are showing activity in the advanced disease setting and are being studied for incorporation into multimodal adjuvant treatment approaches. It is hoped that such advances and a changing treatment paradigm will ultimately result in greater survival for patients with early NSCLC.