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Neoadjuvant chemotherapy in lung cancer

Syed H Jafri and Glenn Mills

Lung cancer is the most commonly diagnosed cancer and is also the leading cause of cancer-related mortality in the USA. More people die from lung cancer than from colorectal, breast and prostate cancers combined. Patients with early-stage lung cancer are treated with surgery, which is followed by adjuvant chemotherapy in stage II and IIIA patients. Neoadjuvant chemotherapy in early-stage lung cancer has been evaluated in many clinical trials with variable results, and the current standard of care for early-stage lung cancer is surgery followed by adjuvant chemotherapy. Patients with locally advanced lung cancer are treated with definitive concurrent chemoradiotherapy. The role of neoadjuvant chemotherapy in this setting has been explored in many clinical trials. Two meta-analyses have demonstrated that neoadjuvant chemotherapy is beneficial in patients with locally advanced lung cancer; however, a large Phase III clinical trial failed to show survival advantage with neoadjuvant chemoradiotherapy followed by surgery compared with chemoradiotherapy alone in locally advanced lung cancer. Therefore, there is no established role of neoadjuvant chemotherapy in early-stage lung cancer and its role in locally advanced lung cancer is still being investigated.