J.Jpn. Surg. Soc.. 115(3): 125-129, 2014

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Feature topic

CURRENT STATUS OF POSTOPERATIVE ADJUVANT CHEMOTHERAPY FOR COMPLETELY RESECTED NON-SMALL LUNG CANCER

Multiple, large, randomized trials assessing the efficacy of adjuvant chemotherapy for resected non-small cell lung cancer (NSCLC) have been reported in recent years. Three of six trials involving 300 or more patients with early-stage NSCLC demonstrated that adjuvant cisplatin-based chemotherapy can significantly improve 5-year survival in carefully selected patients with resected NSCLC. These benefits were confirmed in a meta-analysis of modern cisplatin-based adjuvant trials. The most consistent benefit was reported in patients with resected stage II and IIIA NSCLC. On the other hand, studies from Japan reported that adjuvant therapy with uracil-tegafur (UFT) afforded an improvement of 4% in the 5-year survival rate and a relative risk reduction of 26% in mortality at 5 years among patients with T1-2N0 (stage I) disease. In particular, the Japan Lung Cancer Research Group demonstrated an improvement in the 5-year survival rate of 11%, favoring chemotherapy with UFT in the subset of patients with T2N0 (stage IB) disease. Two published meta-analyses based on abstracts estimated a relative risk reduction in mortality of 11-13% at 5 years. Thus, the information currently available supports the administration of adjuvant chemotherapy for patients who have undergone complete resection of stages IB-IIIA NSCLC. The recent results of biological research indicate that the expression of some tumor markers including ERCC1 should be evaluated to determine which patients are more likely to benefit from chemotherapy. The next advance will be to identify the subsets of patients who will derive the greatest benefit from adjuvant chemotherapy.

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