Adjuvant cisplatin-based chemotherapy for resected NSCLC: one size fits all?

The standard of care for resected stage II - IIIA non-small-cell lung cancer includes adjuvant chemotherapy based on the results of randomized trials using cisplatin regimens. A recent meta-analysis (Lung Adjuvant Cisplatin Evaluation) showed no survival benefit for this modality in stage IB disease. Therefore, the role for stage IB disease remains controversial. The Lung Adjuvant Cisplatin Evaluation meta-analysis, which is based on pooled data of five randomized trials, has shown a 5.3% absolute survival benefit at 5 years. However, long-term results of the International Adjuvant Lung Cancer Trial evaluating adjuvant cisplatin-based chemotherapy in resected non-small-cell lung cancer indicated a possible late adjuvant chemotherapy-related over-mortality. Tumor stage currently is the benchmark standard use for identifying patients who would benefit from adjuvant treatment. In the knowledge of late adjuvant chemotherapy-related over-mortality it is therefore critical to identify subsets of patients who would or would never benefit from adjuvant cisplatin. This review will discuss the extent to which individualized adjuvant treatment can be provided.