Adjuvant chemotherapy of non-small-cell lung cancer

Approximately 25-30% of patients with non-small cell lung cancer (NSCLC) present with early stage disease and undergo surgery with curative intent. Despite complete tumor resection, many of these patients will develop systemic relapses with or without local relapses and will eventually die from the disease. Systemic relapses occur due to the presence of micro-metastatic disease at the time of surgery. In order to treat these micro-metastases in an early stage, adjuvant chemotherapy following complete tumor resection has been studied. A meta-analysis of early trials indicated a trend towards improved survival for adjuvant platinum-based chemotherapy (1) and led to re-evaluation of adjuvant chemotherapy in clinical trials on large patient populations (2-8). Several of these trials demonstrated that adjuvant chemotherapy improves survival (3-6). The survival benefit was then further confirmed in a meta-analysis that included all five cisplatin-based trials (9). Thus adjuvant chemotherapy has been established for patients with stages II and III. Here we summarize the current status of adjuvant chemotherapy in patients with completely resected NSCLC.