Neoadjuvant chemotherapy for non-small cell lung cancer: current North American experience

Recently, North American investigators have searched for effective chemotherapy or chemoradiotherapy regimens that can be employed before definitive surgery or radiation therapy in the treatment of stage III non-small cell lung cancer (NSCLC). Although these efforts have failed to identify a neoadjuvant regiment that clearly improves survival, the data from these trials do provide a direction for continuing research. It is now clear that the criteria for defining patients as operable, potentially operable, or inoperable have been heterogeneous and must be more carefully applied. With the current limited efficacy of chemotherapy in NSCLC, trials comparing different neoadjuvant regimens (chemotherapy, radiation therapy, and a combination of both), as well as comparative trials of definitive therapy with or without neoadjuvant therapy, will be required to clearly establish the role for neoadjuvant therapy in the treatment of this disease.