Physicians from the Bimodality Lung Oncology Team (BLOT) have reported promising results following treatment with chemotherapy prior to surgery (neoadjuvant) compared to surgery alone in patients with early stage non-small cell lung cancer, as recently published in the Journal of Thoracic Cardiovascular Surgery. These results are consistent with previous findings indicating improved responses with neoadjuvant chemotherapy for non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is a type of lung cancer that comprises approximately 75-80% of all lung cancers. NSCLC is further subdivided and named according to the type of cell within the lung in which the cancer originated. These include epidermoid or squamous carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma and undifferentiated carcinoma. Standard treatment options for NSCLC depend on the stage, or extent of the cancer, but may include surgery, radiation therapy and/or chemotherapy. Since long-term survival rates are poor for patients with this disease, research is aimed at determining the most optimal novel therapeutic regimens or treatment combinations in order to achieve higher cure rates.

Recently, neoadjuvant therapy has been an area of research focus for various types of cancer. Some recent clinical studies have shown that patients with NSCLC may benefit from neoadjuvant chemotherapy plus radiation therapy prior to surgery. There are five separate reasons for the use of neoadjuvant or pre-operative treatment strategy: 1) pre-operative treatment can often shrink lung cancers, and therefore may allow more complete surgical removal of the cancer; 2) immediate treatment with chemotherapy and radiation may prevent the spread of cancer by killing cancer cells without delay; 3) surgery involving the removal of a smaller cancer is less extensive and may decrease adverse complications associated with extensive surgery; 4) pre-operative treatment may shrink the cancer enough to allow surgery for patients who otherwise would not be candidates for surgery; 5) patients often cannot tolerate chemotherapy following surgical procedures.

Results from these previous trials have prompted BLOT physicians to conduct further clinical trials evaluating neoadjuvant chemotherapy for patients with NSCLC. One such recent trial involved 94 patients with NSCLC that had not spread to distant sites in the body. Following induction chemotherapy consisting of paclitaxel and carboplatin, 86% of patients underwent a complete surgical removal of their cancer. Following surgery, 45% of patients received post-operative chemotherapy. One year following surgery, approximately 85% of patients survived. The average duration of survival has not yet been determined. Two post-operative deaths occurred, however, there were no other unexpected complications from treatment.

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These results suggest that pre-operative chemotherapy may achieve superior outcomes compared to surgery alone in patients with early-stage NSCLC. Trials are ongoing to determine optimal neoadjuvant regimens for NSCLC. Patients with NSCLC may wish to speak with their physician about the risks and benefits of neoadjuvant chemotherapy or the participation in clinical trials further evaluating this treatment option or other promising therapies. Two sources of information include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Journal of Thoracic Cardiovascular Surgery, Vol 119, pp 429-439, 2000)

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