Adjuvant and induction chemotherapy in non-small cell lung cancer

Summary About 25%-30% of patients with non-small cell lung cancer can be resected with curative intent. However, systemic relapses occur in up to 70% of these patients. Thus, postoperative adjuvant chemotherapy was evaluated in several randomised trials but the results of these trials were inconclusive with a survival benefit only in some trials. Shortcomings of these trials included low number of patients, poor patient compliance and inadequate chemotherapy protocols. A recent meta-analysis suggested an absolute survival benefit of 5% at five years for postoperative cisplatin-based chemotherapy as compared to surgery alone. Thus adjuvant chemotherapy with both improved chemotherapy protocols and improved anti-emetics is currently re-evaluated in several randomised trials on large patient populations. Patients with locally advanced (stage III) non-small cell lung cancer require a multimodal approach with both local therapies (surgery, radiotherapy or both) and systemic chemotherapy. Patients with completely resected stage IIIA disease should be enrolled in randomised adjuvant chemotherapy trials with or without radiotherapy. Patients with clinically stage IIIA and selected patients with stage IIIB are candidates for induction chemotherapy followed by surgery. The remaining stage III patients should receive combined chemoradiotherapy.