Molecularly tailored adjuvant chemotherapy for resected non-small cell lung cancer: a time for excitement and equipoise

J Thorac Oncol. 2008 Jan;3(1):84-93. doi: 10.1097/JTO.0b013e31815efe24.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Biomarkers, Tumor / analysis*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Chemotherapy, Adjuvant
  • Cisplatin / therapeutic use
  • Clinical Trials as Topic
  • Cyclin-Dependent Kinase Inhibitor p27
  • DNA-Binding Proteins / genetics
  • Endonucleases / genetics
  • Follow-Up Studies
  • Genes, erbB-1 / genetics
  • Humans
  • Intracellular Signaling Peptides and Proteins / genetics
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Membrane Transport Proteins / genetics
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins / genetics
  • Neoplasm Staging
  • Proto-Oncogene Proteins / genetics
  • Proto-Oncogene Proteins p21(ras)
  • Randomized Controlled Trials as Topic
  • Survival Analysis
  • Time Factors
  • Treatment Outcome
  • Tubulin / genetics
  • ras Proteins / genetics

Substances

  • Antineoplastic Agents
  • Biomarkers, Tumor
  • CDKN1B protein, human
  • DNA-Binding Proteins
  • Intracellular Signaling Peptides and Proteins
  • KRAS protein, human
  • Membrane Transport Proteins
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins
  • Proto-Oncogene Proteins
  • Tubulin
  • Cyclin-Dependent Kinase Inhibitor p27
  • ERCC1 protein, human
  • Endonucleases
  • Proto-Oncogene Proteins p21(ras)
  • ras Proteins
  • Cisplatin