JLE

Bulletin du Cancer

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Neoadjuvant chemotherapy in non small cell lung cancer Volume 93, issue 11, Novembre 2006

Authors
Département de médecine, Institut Gustave-Roussy, Villejuif, Service d’oncologie médicale, Groupe hospitalier Diaconesses-Croix-Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, Institut national du cancer, Paris

Standards of care for non small cell lung cancer (NSCLC) are not, yet, totally established. The role of induction chemotherapy is still debated while it has been established that adjuvant cisplatin based chemotherapy improve overall survival in completely resected patients. We will review the feasibility and efficacy of induction chemotherapy for patients with early-stage and locally advanced NSCLC, particularly with N2 disease. In the neoadjuvant setting, a 32 to 60 % response rate is awaited considering the high treatment compliance. Near to 10 % pathologic complete response rate is reported. Nevertheless, no large randomised phase III trial has demonstrated that induction chemotherapy could prolong patients overall survival. Suboptimal cytotoxic combinations and an increased surgical mortality might explain this result. Studies suggested that patient’s subgroups (as downstaged N2 disease) could benefit from induction treatment. This still need to be confirmed in randomised trial and meta-analysis based on individual data.