Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer

ABSTRACT

Introduction: Adjuvant platinum based chemotherapy is accepted as standard of care in stage II and III non-small cell lung cancer (NSCLC) patients and is often considered in patients with stage IB disease who have tumors ≥ 4 cm. The survival advantage is modest with approximately 5% at 5 years.

Areas covered: This review article presents relevant data regarding chemotherapy use in the perioperative setting for early stage NSCLC. A literature search was performed utilizing PubMed as well as clinical trial.gov. Randomized phase III studies in this setting including adjuvant and neoadjuvant use of chemotherapy as well as ongoing trials on targeted therapy and immunotherapy are also discussed.

Expert commentary: With increasing utilization of screening computed tomography scans, it is possible that the percentage of early stage NSCLC patients will increase in the coming years. Benefits of adjuvant chemotherapy in early stage NSCLC patients remain modest. There is a need to better define patients most likely to derive survival benefit from adjuvant therapy and spare patients who do not need adjuvant chemotherapy due to the toxicity of such therapy. Trials for adjuvant targeted therapy, including adjuvant EGFR-TKI trials and trials of immunotherapy drugs are ongoing and will define the role of these agents as adjuvant therapy.

KEYWORDS:

• Non-small-cell lung cancer
• early-stage
• adjuvant chemotherapy
• neoadjuvant chemotherapy
• adjuvant targeted therapy
• adjuvant immunotherapy

Declaration of interest

SM Gadgeel has sat on the advisory board for Genentech, Roche, Ariad, AstraZeneca and Pfizer. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has disclosed that they have acted as a speaker for AstraZeneca, Roche, and Pfizer. They have also acted in an advisory role of AstraZeneca, Boehringer Ingelheim, Bristol Meyers Squibb, Celgene, G1 Therapeutics, Merck, Pfizer, Pierre Fabre, and Roche. Lastly, they have received financial support due to travels undertaken while working for Roche. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.