Purpose: The role of adjuvant chemotherapy in the treatment of non-small-cell lung cancer (NSCLC) is described.
Summary: The intrinsic resistance of NSCLC tumors to chemotherapy necessitates the use of complete surgical resection of the malignant growth as the primary modality of treatment; however, only about one third of patients are appropriate candidates for surgical resection. While several cytotoxic combinations have been used to treat metastatic NSCLC, no single regimen is considered the standard of care. Given the poor prognosis of patients with NSCLC, adjuvant chemotherapy has been investigated as a treatment option but has not demonstrated a consistent survival benefit. Several recent studies have sought to clarify the role of adjuvant chemotherapy in the treatment of NSCLC: the Big Lung Trial, the International Adjuvant Lung Cancer Trial (IALT), the Adjuvant Lung Project Italy trial, and a study of the combination of uracil and tegafur, which is not yet available in the United States. The IALT, the largest trial among the four and sufficiently powered to detect a survival benefit, revealed a modest increase in survival. Complicating the issue is the financial cost of adjuvant therapy, especially in light of the small survival benefit gained.
Conclusion: The use of adjuvant chemotherapy in patients with NSCLC can lead to a modest increase in survival. Platinum-based regimens are the most studied and should be considered the regimens of choice. However, further studies are needed to determine the optimal regimen and patient population that would derive the most benefit from this treatment.