Neoadjuvant chemotherapy of locally advanced non-small cell lung cancer

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 1995-04, Vol.12, p.S107-S118
• Main Authors: Pujol, Jean-Louis, Chevalier, Thierry Le, Ray, Patrice, Gautier, Véronique, Rouanet, Philippe, Arriagada, Rodrigo, Grunenwald, Dominique, Michel, François-Bernard
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Chemotherapy, Adjuvant; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Combined Modality Therapy; Feasibility; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Neoadjuvant chemotherapy; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Non-small cell lung cancer; Randomization; Randomized Controlled Trials as Topic; Remission Induction; Surgery; Survival Rate; TNM classification; Treatment Outcome
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/0169-5002(95)00426-2

Neoadjuvant chemotherapy was tested in non-small cell lung cancer in an attempt to increase the resectability of the tumor and to treat the microscopic metastatic disease known to be responsible for the majority of failures in surgically treated patients. This review deals with published trials. Most of them are feasibility studies in Stage III NSCLC. Obviously, the heterogeneity of eligibility criteria from one study to another prevents general conclusions on the usefulness of neoadjuvant chemotherapy. However, it is possible to conclude that neoadjuvant chemotherapy has an antitumor activity: the majority of the studies report a 60% objective response rate including a significant number of complete responses and a 50% complete resection rate. Neoadjuvant chemotherapy does not increase morbidity after surgery except when it is combined with preoperative radiation therapy. At the time of writing, one Phase III randomized study comparing neoadjuvant chemotherapy followed by surgery with surgery alone has been published. This study concludes that the combined modality treatment improves the survival of patients with locally advanced non-small cell lung cancer. Taken as a whole, the literature deserves further studies to determine the place of neoadjuvant chemotherapy in lung cancer.