The Role of Induction Therapy for Resectable Non-Small Cell Lung Cancer
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LEADING ARTICLE
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The Role of Induction Therapy for Resectable Non-Small Cell Lung Cancer Thomas E. Stinchcombe and Mark A. Socinski Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
Abstract
Lung cancer is the leading cause of cancer death among men and women in the US. Surgical resection is potentially curative; however, even after complete resection many patients experience systemic recurrence and subsequently die of their disease. As a means of reducing the chances of recurrence there has been significant interest in combining chemotherapy with surgical resection. Recently, several large phase III clinical trials have demonstrated a significant survival benefit with adjuvant or postoperative cisplatin-based chemotherapy. Use of preoperative or induction chemotherapy has also been an area of active investigation; however, the trials that have demonstrated a survival benefit were small in size, and there has not been widespread acceptance of this treatment approach. The trials of induction chemoradiotherapy have generally been performed in patients with locally advanced disease, frequently in patients with involvement of the level 2 mediastinal lymph nodes (N2). The results of the recent US Intergroup trial, 0139, which compared induction chemoradiotherapy followed by surgical resection versus nonsurgical therapy with chemoradiotherapy in patients with resectable stage IIIA-N2 disease, revealed equivalent overall survival between the two treatment approaches. The results of an unplanned subset analysis of patients who were treated with lobectomy in the surgical arm have generated significant interest and debate. When the strategy of induction therapy is used, pathological clearance of the mediastinal lymph nodes is a significant prognostic factor for overall survival. Current investigations are attempting to determine the optimal method of assessing this critical prognostic factor. The toxicity, efficacy and proper selection of patients for induction therapy, particularly induction chemoradiotherapy, will be assessed in ongoing and future clinical trials.
Lung cancer is the leading cause of cancer death among men and women in the US.[1] It is estimated that in the US in 2006 approximately 174 000 people will receive the diagnosis of lung cancer, and lung cancer will be responsible for approximately 162 000 deaths.[1] Approximately 85% of patients
will have the non-small cell histology, for which surgical resection is a therapeutic option.[2] Furthermore, one-third of patients will present with early stage lung cancer, stage I or II, where disease is confined to the pulmonary parenchyma or pulmonary lymph nodes, and surgical resection is both tech-
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Table I. Stage prevalence and percentage of relapse with surgical therapy alone in patients with non-small cell lung cancer[3,8] Stage (% prevalence)
Substage
(TNM)
5-year survival (
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