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A Journal on Surgery

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Minerva Chirurgica 2009 December;64(6):611-28

language: English

Neoadjuvant chemotherapy for non-small cell lung cancer

Pinder-Schenck M., Bepler G.

Thoracic Oncology, Department of Medicine and Oncological Sciences, University of South Florida, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA


Even with aggressive surgical treatment, relapse rates remain high for patients with resectable non-small cell lung cancer (NSCLC). In an effort to improve survival in these patients, numerous clinical trials have evaluated neoadjuvant and adjuvant chemotherapy. Three large, randomized clinical trials and two meta-analyses have demonstrated a survival benefit for adjuvant cisplatin-based chemotherapy compared to surgery alone. Adjuvant chemotherapy has become the standard of care for patients with resected NSCLC. A neoadjuvant approach offers several potential advantages over adjuvant therapy, including earlier treatment of microme-tastatic disease, improved compliance and pathologic confirmation of efficacy. Rando-mized trials have shown neoadjuvant therapy to be feasible and safe and some studies have yielded promising efficacy. The applicability of these results has been limited due to patient heterogeneity, imprecise staging and lack of standardization with respect to inclusion of radiation therapy. With novel agents, improved staging, better supportive care and relevant molecular markers, a neoadjuvant strategy is promising for future clinical trials in NSCLC.

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