Abstract
Pre-operatve (neoadjuvant) chemotherapy for patients with resectable nonsmall cell lung cancer has been studied since the 1980s, and no individual trial has demonstrated a statistically significant survival benefit for patients with resectable stage I-II NSCLC. Several phase III studies were cut short by the interim discovery of a survival benefit for postoperative (adjuvant) chemotherapy. For patients with mediastinoscopy-proven, resectable stage IIIA/N2 NSCLC, single-modality neoadjuvant chemotherapy is a standard of care. Whether patients with N2 disease should also receive pre-operative radiation therapy is a matter of debate, addressed in other chapters in this textbook. Available evidence has established that neoadjuvant chemotherapy does not interfere with surgery, results in improved drug delivery compared to the postoperative approach, and provides surrogate efficacy endpoints-such as radiologic response, pathologic response, and downstaging-which predict disease free and overall survival and may be used to measure the efficacy of new drugs when applied in the care of early-stage patients. Although neoadjuvant chemotherapy for patients with stage I-II disease remains investigational, available evidence, and favorable results of meta-analyses, reassure that a neoadjuvant platform may be boldly employed in new drug and biomarker discovery efforts.
Original language | English (US) |
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Title of host publication | Lung Cancer |
Subtitle of host publication | Fourth Edition |
Publisher | Wiley-Blackwell |
Pages | 290-308 |
Number of pages | 19 |
ISBN (Electronic) | 9781118468791 |
ISBN (Print) | 9781118468746 |
DOIs | |
State | Published - May 27 2014 |
Keywords
- Chemotherapy
- Early stage
- Neoadjuvant
- Nonsmall cell lung cancer
- Pre-operative
- Resectable
- Surrogate efficacy endpoints
- Window of opportunity
ASJC Scopus subject areas
- General Medicine