Role of Adjuvant Chemotherapy in NSCLC (Stages I to III)

Lung cancer is the leading cause of cancer mortality in the Western world with an estimated 222,520 new cases diagnosed in the United States in 2010. Lung cancer is broadly subdivided into two types, small cell and non-small cell, which account for approximately 15% and 85% of cases, respectively. Five-year overall survival of patients with non-small cell lung cancer (NSCLC) remains low at 17%. Even in the case of patients with sufficiently early cancer to be candidates for curative surgery, long-term survival is not guaranteed. When analyzed by stage, 5-year survival rates for stage I, stage II, and stage IIIA disease are 60%, 40%, and 25%, respectively. Recurrence or relapse of disease at distant sites is common and has prompted considerable research focused on chemotherapy for systematic therapy in an effort to improve long-term survival. As such, the use of adjuvant chemotherapy for earlystage NSCLC continues to evolve with the completion of numerous clinical trials and meta-analyses (Table 1), the development of novel chemotherapeutic agents, and the identification of biomarkers associated with prognosis and response to chemotherapeutic agents.