Adjuvant and neoadjuvant treatments for NSCLC

In stage III non-small cell lung cancer (NSCLC), the use of induction chemotherapy prior to radiotherapy produces a significant increase in median survival of three to four months (from 11 to 14 months), a benefit which appears to be achieved through improved systemic control of the disease. Hyperfractionated radiotherapy, although it enhances local control, seems not to improve survival. Concurrent chemoradiotherapy has emerged as the most successful strategy. It led to increased locoregional control and to a 3-4 month improvement of median survival when compared with induction chemotherapy prior to radiotherapy. Docetaxel is a radiosensitizing agent and has been extensively investigated in phase I/II settings of concurrent chemoradiotherapy. Use of the other cytotoxics such as paclitaxel, or irinotecan in concurrent chemoradiotherapy strategies is also feasible. Of particular interest are the results of SWOG 9504, a phase II study in which cisplatin/etoposide concurrent chemoradiotherapy was followed by three cycles of docetaxel consolidation. Median survival is 26 months, 1-year survival 76% and 3-year survival 40%. These survival data, achieved in pathologically staged IIIB patients, are highly encouraging and support further evaluation of this approach. Among stage III patients eligible for radical treatment with surgery or radiotherapy, the addition of neoadjuvant docetaxel at 100 mg/m² for three cycles is tolerable and appears to be associated with a trend towards increased survival.