New approaches in the adjuvant and neoadjuvant therapy of non-small cell lung cancer, including docetaxel (Taxotere) combinations.

Among the issues debated in the therapy of early non-small cell lung cancer are whether postoperative chemotherapy improves survival, whether postoperative radiation therapy has some benefit either in local control or in the prevention of distant recurrence, and whether neoadjuvant treatment benefits patients with stage IIIA disease. The role of surgery is being investigated in the North American Intergroup Trial, in which concurrent chemoradiotherapy followed by surgery and postoperative chemotherapy is compared with concurrent chemoradiotherapy alone. Based on the evidence to date, surgery appears to benefit patients in whom complete resection is attained. However, even in these patients, the detection of tumor DNA in serum is a clear indication for postoperative chemotherapy. A trial undertaken by the Spanish Lung Cancer Group is currently investigating a novel neoadjuvant regimen involving gemcitabine, cisplatin, and weekly docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) in patients with mediastinoscopically confirmed N2 disease.