Non-small cell lung cancer therapy: Prospects

In focusing on future directions in the treatment of non-small cell lung cancer (NSCLC), the authors evidence that the results achieved thus far in the treatment of metastatic disease have proved to be disappointing. Adjuvant chemotherapy or radiotherapy following surgical resection were not able to improve overall survival. The role of surgery still remains of primary importance, but it can be performed in only one fourth of NSCLC patients, with a 5 year survival rate of 20-30% of stage III patients. The objective of primary or neoadjuvant therapy is to enable an otherwise unresectable or marginally resectable NSCLC to be surgically resected. The new staging system for lung cancer allowed the identification of subgroups of patients potentially eligible for neoadjuvant therapy (Stage IIIa or IIIa N2 bulky), thus avoiding a surgical approach in more advanced disease. Early neoadjuvant trials of chemotherapy associated with radiotherapy have not yielded promising results. Recent studies of neoadjuvant chemotherapy achieved a 50-60% rate of complete surgical resections, up to 80% of resections in patients who have responded to neoadjuvant chemotherapy. Recently, some phase III trials showed an improved disease-free survival and overall survival in patients treated with neoadjuvant chemotherapy compared with patients treated with surgery alone. Nevertheless, further studies with longer follow-up times are needed to draw definitive conclusions. Data reported by MSKCC are exciting and encourage a cautious optimism about the treatment of NSCLC which has been for a long time a disease lacking in clinical results