Summary
The efficacy of postoperative adjuvant chemotherapy for patients with completely resected NSCLC has been elucidated in several large randomized trials. A meta-analysis of five of the recently performed cisplatin-based chemotherapy trials, the Lung Adjuvant Cisplatin Evaluation (LACE) meta-analysis, confirmed that adjuvant cisplatin-based chemotherapy improves survival of patients with completely resected NSCLC. Thus, cisplatin-based adjuvant chemotherapy is now considered as the standard of care for patients with completely resected NSCLC stage, II–III. According to the LACE meta-analysis, patients with stage IA NSCLC should not receive adjuvant chemotherapy but it could be considered for selected patients with stage IB disease. Because the overall benefit of adjuvant chemotherapy is small, new treatment strategies including customized chemotherapy, integration of molecular-targeted therapies, and immunotherapy are under investigation and may show better results in patients with completely resected early-stage NSCLC.
Similar content being viewed by others
References
Scagliotti GV, Fossati R, Torri V, et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell lung cancer. J Natl Cancer Inst, 95: 1453–1461, 2003
Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med, 350: 351–360, 2004
Kato H, Ichinose Y, Ohta M, et al. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med, 350: 1713–1721, 2004
Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med, 352: 2589–2597, 2005
Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol, 7: 719–727, 2006
Strauss G, Herndon J, Maddaus M, et al. Adjuvant chemotherapy in stage IB non-small cell lung cancer (NSCLC): Update of Cancer and Leukemia Group B (CALGB) protocol 9633. J Clin Oncol, 24: 365s, 2006 (abstr 7007)
Pignon J, Tribodet H, Scagliotti G, et al. Lung Adjuvant Cisplatin Evaluation (LACE): a pooled analysis of five randomized clinical trials including 4,584 patients. J Clin Oncol, 24: 366s, 2006 (abstr 7008)
Horn L, Sandler AB, Putnam JB, Jr, et al. The rationale for adjuvant chemotherapy in stage I non-small cell lung cancer. J Thorac Oncol, 2: 377–383, 2007
Pisters KM, Evans WK, Azzoli CG, et al. Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I-IIIA resectable non small-cell lung cancer guideline. J Clin Oncol, 25: 5506–5518, 2007
Lord RV, Brabender J, Gandara D, et al. Low ERCC1 expression correlates with prolonged survival after cisplatin plus gemcitabine chemotherapy in non-small cell lung cancer. Clin Cancer Res, 8: 2286–2291, 2002
Ceppi P, Volante M, Novello S, et al. ERCC1 and RRM1 gene expressions but not EGFR are predictive of shorter survival in advanced non-small-cell lung cancer treated with cisplatin and gemcitabine. Ann Oncol, 17: 1818–1825, 2006
Olaussen KA, Dunant A, Fouret P, et al. DNA repair by ERCC1 in non-small-cell lung cancer and cisplatin-based adjuvant chemotherapy. N Engl J Med, 355: 983–991, 2006
Azuma K, Komohara Y, Sasada T, et al. Excision repair cross-complementation group 1 predicts progression-free and overall survival in non-small cell lung cancer patients treated with platinum-based chemotherapy. Cancer Sci, 98: 1336–1343, 2007
Simon G, Sharma A, Li X, et al. Feasibility and efficacy of molecular analysis-directed individualized therapy in advanced non-small-cell lung cancer. J Clin Oncol, 25: 2741–2746, 2007
Filipits M, Pirker R, Dunant A, et al. Cell cycle regulators and outcome of adjuvant cisplatin-based chemotherapy in completely resected non-small-cell lung cancer: the International Adjuvant Lung Cancer Trial Biologic Program. J Clin Oncol, 25: 2735–2740, 2007
Seve P, Mackey J, Isaac S, et al. Class III beta-tubulin expression in tumor cells predicts response and outcome in patients with non-small cell lung cancer receiving paclitaxel. Mol Cancer Ther, 4: 2001–2007, 2005
Seve P, Isaac S, Tredan O, et al. Expression of class III {beta}-tubulin is predictive of patient outcome in patients with non-small cell lung cancer receiving vinorelbine-based chemotherapy. Clin Cancer Res, 11: 5481–5486, 2005
Taron M, Rosell R, Felip E, et al. BRCA1 mRNA expression levels as an indicator of chemoresistance in lung cancer. Hum Mol Genet, 13: 2443–2449, 2004
Rosell R, Skrzypski M, Jassem E, et al. BRCA1: A novel prognostic factor in resected non-small-cell lung cancer. PLoS ONE, 2: e1129, 2007
Pirker R, Filipits M, Dunant A, et al. IALT-Bio: a challenging research to improve adjuvant chemotherapy of completely resected NSCLC. J Thorac Oncol, 2: S397–S398, 2007 (abstr D3-03)
Filipits M, Haddad V, Schmid K, et al. Multidrug resistance proteins do not predict benefit of adjuvant chemotherapy in patients with completely resected non-small cell lung cancer: International Adjuvant Lung Cancer Trial Biologic Program. Clin Cancer Res, 13: 3892–3898, 2007
Cobo M, Isla D, Massuti B, et al. Customizing cisplatin based on quantitative excision repair cross-complementing 1 mRNA expression: a phase III trial in non-small-cell lung cancer. J Clin Oncol, 25: 2747–2754, 2007
Meert AP, Martin B, Delmotte P, et al. The role of EGF-R expression on patient survival in lung cancer: a systematic review with meta-analysis. Eur Respir J, 20: 975–981, 2002
Pirker R, Minar W, Filipits M. Integrating EGFR targeted therapies into platinum-based chemotherapy regimens for newly diagnosed non-small cell lung cancer. Clinical Lung Cancer (in press)
Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med, 353: 123–132, 2005
Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med, 355: 2542–2550, 2006
Sun Y, Wang J, Liu Y, et al. Results of phase III trial of Endostar™ (rh-endostatin, YH-16) in advanced non-small cell lung cancer (NSCLC) patients. J Clin Oncol, 23: 654s, 2005 (abstr 7138)
Vansteenkiste J, Zielinski M, Linder A, et al. Final results of a multi-center, double-blind, randomized, placebo-controlled phase II study to assess the efficacy of MAGE-A3 immunotherapeutic as adjuvant therapy in stage IB/II non-small cell lung cancer (NSCLC). J Clin Oncol, 25: 398s, 2007 (abstr 7554)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Filipits, M., Pirker, R. Adjuvant therapy in non-small cell lung cancer: Current status and future perspectives. memo 1, 57–60 (2008). https://doi.org/10.1007/s12254-008-0017-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12254-008-0017-2