Adjuvant chemotherapy for non-small cell lung cancer

In the late 1970s and early 1980s, the Lung Cancer Study Group conducted a series of adjuvant chemotherapy trials in patients with resected non-small cell lung cancer. Although some of these trials yielded modest survival benefit, the length of improved survival essentially equaled the time spent receiving chemotherapy. Consequently, few physicians routinely employ postoperative chemotherapy in spite of its theoretical appeal. Possible explanations for the failure of adjuvant chemotherapy to provide meaningful prolongation of survival in non-small cell lung cancer include lack of effective chemotherapy, incorrect chemotherapy regimen, inadequate dose intensity, and possibly inadequate trial design. Future postoperative adjuvant trials should focus on treating patients with resected early stage lesions (T1N1, T2N1, T2N0). What role, if any, newer antineoplastic agents will play in the postoperative setting remains to be determined. Neoadjuvant induction chemotherapy may well prove to be a superior treatment strategy and deserves further investigation.