Advances in adjuvant systemic therapy for non-small-cell lung cancer

Abstract

Non-small-cell lung cancer remains a leading cause of death around the world. For most cases, the only chance of cure comes from resection for localised disease, however relapse rates remain high following surgery. Data has emerged over recent years regarding the utility of adjuvant chemotherapy for improving disease-free and overall survival of patients following curative resection. This paper reviews the clinical trials that have been conducted in this area along with the studies integrating radiation therapy in the adjuvant setting. The role of prognostic gene signatures are reviewed as well as ongoing clinical trials including those incorporating biological or targeted therapies.

Keywords: Carcinoma, Non-small-cell lung, Chemotherapy, Adjuvant, Radiotherapy, Biological therapy, Biomarker

Core tip: Improvement in survivals of patients with resected non-small lung cancer has been rather modest. Adjuvant systemic chemotherapy with high dose cisplatin and vinorelbine has been established to be beneficial in improving disease free and overall survival in stage II and IIIA but not stage I patients. This benefit is observed also in elderly patients. Post-operative radiation therapy has a deleterious effect on early stage tumour but appears to improve survival and reduce local recurrence in higher risk stage III or N2 disease with modern techniques. The availability of targeted biologicals and biomarker development may allow future selection of high risk groups who benefit from adjuvant treatments.