Postoperative chemotherapy for resected non-small-cell lung cancer

Surgical resection is the treatment of choice for patients with stage I and stage II non-small-cell lung cancer (NSCLC--squamous cell, adenocarcinoma, and large-cell carcinoma). Distant recurrence is an important cause of death after complete surgical resection, occurring in 30-60% of patients. Postoperative adjuvant chemotherapy has been studied for over three decades in randomized controlled trials but is not considered standard therapy for this group of patients. The use of multidrug regimens including cisplatin has produced a prolongation of disease-free survival, but until recently no overall survival benefit has been shown. A new generation of studies is now warranted, employing the more active combinations identified in the 1980s or incorporating one of the many promising new agents being tested in NSCLC. The use of improved supportive care measures, such as the new serotonin receptor antagonist antiemetics, is required to increase compliance with chemotherapy in this group of patients. With this approach, the real goal of adjuvant system chemotherapy--to increase the number of patients actually cured of their cancer--may be attained in early stage NSCLC.