Preoperative chemotherapy for non-small cell lung cancer

Surgery has been considered the standard of care in patients with early-stage non-small cell lung cancer (NSCLC). as well as in some cases of stage III Cor a long time. Poor survival after complete resection has led to the search for new therapeu tie strategies such as combining anticancer treatments. However: at the present time, attempts to combine chemotherapy and radiotherapy after surgery have failed to show any significant impact on survival among patients with completely resected NSCLC. Preoperative chemotherapy may give superior results to postoperative systemic treatment. In stage IIIA NSCLC, phase ii studies have shown the feasibility and efficacy of this approach with response rates higher than that observed in more advanced disease. Chemotherapy alone and its combination with radiotherapy have been tested. The most recent trials have demonstrated the feasibility of concomitant chemoradiotherapy in stage IIIA NSCLC. Three small randomized trials have been published in stage IIIA NSCLC. They argue strongly in favour of preoperative chemo-therapy with a significant improvement in overall survival. A large french study included over 350 patients. A multivariate analysis using a Cox model showed a decreased relative risk of death in the preoperative chemo-therapy arm in stage \B, II and IIIA. Newer active agents such as paclitaxel, gemcitabine, vinorelbine and docetaxel may play a role in the improvement of lung cancer survival when used preoperatively. It is essential that clinical investigators collaborate in large clinical trials. (C) 2001 Harcourt Publishers Ltd.