Molecularly tailored adjuvant chemotherapy for resected non-small cell lung cancer: a time for excitement and equipoise.
In patients with previously-untreated, completely-resected pathologic stage II-III non-small cell lung cancer, 4 months of postoperative cisplatin-based chemotherapy reduces the risk of death by approximately 20%. To date, the only prospectively validated prognostic and predictive factor which can be used to guide clinical practice is pathologic stage. Higher stage patients have a worse prognosis, but derive more benefit from adjuvant chemotherapy. Numerous molecular markers are being developed with the potential to help decide which patients to treat with adjuvant chemotherapy, and which drugs to use. This paper will review the molecular markers which are having immediate impact on treatment decisions in routine practice, and which merit further study in the next generation of adjuvant chemotherapy trials.
Azzoli
Christopher G
CG
Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York 10021, USA. azzolic@mskcc.org
Park
Bernard J
BJ
Pao
William
W
Zakowski
Maureen
M
Kris
Mark G
MG
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D050760:Cyclin-Dependent Kinase Inhibitor p27; D004268:DNA-Binding Proteins / Q000235:genetics; D004720:Endonucleases / Q000235:genetics; D005500:Follow-Up Studies; D018773:Genes, erbB-1 / Q000235:genetics; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins / Q000235:genetics; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D026901:Membrane Transport Proteins / Q000235:genetics; D000089762:Multidrug Resistance-Associated Protein 2; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000235:genetics; D009367:Neoplasm Staging; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014404:Tubulin / Q000235:genetics; D018631:ras Proteins / Q000235:genetics
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D002945:Cisplatin; D050760:Cyclin-Dependent Kinase Inhibitor p27; D004268:DNA-Binding Proteins; D004720:Endonucleases; D047908:Intracellular Signaling Peptides and Proteins; D026901:Membrane Transport Proteins; D000089762:Multidrug Resistance-Associated Protein 2; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D014404:Tubulin; D018631:ras Proteins; C436291:CDKN1B protein, human; C117307:KRAS protein, human; C071447:ERCC1 protein, human