Preoperative chemotherapy for locally advanced non-small cell lung cancer

Recently, the field of preoperative chemotherapy for non-small cell lung cancer has been the focus of phase II trials. Extensive experience with preoperative therapy has been reported by such study groups as the Rush-Presbyterian group, the Memorial Sloan-Kettering Cancer Center, the Dana Farber Institute, the University of Toronto, and the Lung Cancer Study Group. The studies by these and other investigative groups are reviewed here, and, although all but one of the studies was flawed by the lack of a control arm, results are encouraging. Comparison of data from the various studies is difficult due to differences in preoperative staging, but it appears that 60% to 75% of patients may be expected to respond to one of a number of preoperative regimens. The majority of responders will be able to go on to surgical resection, and approximately 10% of patients initially entered into a study are likely to attain histologic complete response, with correspondingly higher rates for those who undergo surgery. Toxicity rates are significant and survival data are not yet conclusive, however, and it is clear that a controlled trial is needed.