[Therapeutic strategies in neoadjuvant therapy of non-small cell lung cancer: benefits of gemcitabine].
Stages of non-small cell lung cancer (NSCLC) that are potential candidates for surgical resection have been treated in several ways: surgery alone is curative in only two-thirds of cases and post-operative radiotherapy (RT) provides only weak control of advanced-stage disease. Since metastatic recurrence is due to the presence of micrometastases, chemotherapy (CT) can be envisaged, even at an early stage of the disease--first with the CT/RT induction combination, which improves survival (median survival: 15 months) and the resection rate (70%). Recent studies on neoadjuvant therapy have evaluated the usefulness of different induction CT regimens. Among these, the gemcitabine/cisplatin study protocol (GC), set up in a phase II study for patients with stage IIIA N2 NSCLC, was very effective [objective response (OR): 70.2%; median survival: 19 months] and should be promising for stages IB and II. Other studies involving platinum analogs have shown good OR rates inducing a high resection rate and a reduction in the spread to mediastinal lymph nodes. Major studies are ongoing, one of which compares GC + surgery versus surgery alone (stages IB-IIIA); the other regimen aims to evaluate GC versus paclitaxel/carboplatin as well as two induction strategies.
Van Zandwijk
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Département d'Oncologie Thoracique, Netherlands Cancer Institute, 1066 CX Amsterdam, Pays Bas. zandwijk@nki.nl
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D020360:Neoadjuvant Therapy / Q000379:methods*; D015996:Survival Rate; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine