The role of neoadjuvant chemotherapy in NSCLC

Neoadjuvant chemotherapy to reduce tumor size before surgery or radiologic treatment is now a feasible option in the treatment of non-small cell lung cancer (NSCLC). Patients in clinical stage IIIA N2 of the disease who were previously a poor prognostic subset when treated with surgery are now being treated with neoadjuvant chemotherapy, followed by surgery or radiotherapy, in an attempt to improve survival rates. Published trials of neoadjuvant chemotherapy report response rates of 50 to 80% and median survival of 18-27 months. Two small trials have reported striking benefits of neoadjuvant chemotherapy over surgery alone. Other larger ongoing trials should answer some of the questions raised by these two trials.