Neoadjuvant Chemotheraoy

Understanding Neoadjuvant Chemotherapy

The biggest risk with lung cancer, is spread through the bloodstream to spread to other areas of the body (metastases.) For this reason many studies have been completed giving chemotherapy after initial treatment (surgery or radiation) in an effort to prevent distant spread (adjuvant chemotherapy.)

Studies using chemotherapy prior to surgery (referred to as neoadjuvant chemotherapy) have shown promise. In the randomized trial by Rosell survival was increased from 8 months to 26 months. RTOG 88-08 trial showed that chemo prior to radiation improved survival (20%/2y to 31%.) A SWOG 8805 trial also reported good results for stage IIIA (27%/3y) and particularly IIIB (24%/3y) with neoadjuvant chemo/radiation.

NCI Recomendation:
Stage IIIA. The use of preoperative (i.e., neoadjuvant) chemotherapy has been effective in 2 small randomized studies of a total of 120 patients with stage IIIA NSCLC. In both studies, the 58 patients randomized to 3 cycles of cisplatin-based chemotherapy before surgery had a median survival more than 3 times as long as patients treated with surgery but no chemotherapy. Two additional single-arm studies have evaluated either 2 to 4 cycles of combination chemotherapy or combination chemotherapy plus chest irradiation for 211 patients with histologically confirmed N2 stage IIIA NSCLC. In these studies, 65% to 75% of patients had a resection of their cancers, and 27% to 28% of patients were alive 3 years later. These results are encouraging, and combined-modality therapy with neoadjuvant chemotherapy with surgery and/or chest radiation therapy should be considered for patients with good performance status who have stage IIIA NSCLC.