Adjuvant chemotherapy for resectable non-small-cell lung cancer: where is it going?

Following the 1995 meta-analysis on the role of postoperative chemotherapy in NSCLC, many randomized controlled trials (RCTs) have evaluated the effect of adjuvant cisplatin-based chemotherapy in non-small-cell lung cancer (NSCLC), adding substantially to the existing evidence. The LACE pooled analysis included a total of 4584 patients accrued in five recent cisplatin-based adjuvant trials. It confirmed the benefit of adjuvant chemotherapy (P = 0.0043). In addition, it showed that adjuvant cisplatin-based chemotherapy is detrimental in stage IA resected NSCLC; it also indicated that the combination of vinorelbine and cisplatin offered a higher benefit compared with older doublets or triplets. The individual-databased meta-analysis was also updated with a total of >10,000 patients. It confirmed the significant effect of postoperative chemotherapy, with or without postoperative radiotherapy, with an overall significant benefit of 4% at 5 years. The recent results of biological programmes indicate that the expression of some tumour markers including ERCC1 be evaluated in order to determine which patients are more likely to benefit from chemotherapy. If these results are confirmed, tailored therapy might be the next progress for resected NSCLC.