Study of Role of Neoadjuvant Chemotherapy in Non-Small Lung Cancer

Abstract

Background: Neoadjuvant chemotherapy for patients with non-smell lung cancer was studied before undergoing surgery according to the response.

Methods: 85 enrolled Patients treated from Jan 2009 till Dec 2011 with neoadjuvant chemotherapy. 75 pts males and 10 pts females.48 patients (56,5% ) had less than 60 years. 58 patients (68,2%) had Squamous cell carcinoma subtype (SCC) , while the other 27 patients (31,8%) had (Non SCC). All patients underwent pretreatment evaluation at AL BAYROUNI University cancer center. Some patients (32%) had complete mediastinoscopy staging, and all were believed to be poor candidates for up-front surgery because of the bulky disease. Different chemotherapeutic protocols were employed (Gemcitabine/cisplatin) (Docetaxel/cisplatine) and (vinorelbine/ cisplatine). Study end points included resectability, pathologic response, local-regional control,and the best chemotherapy regimen . An exploratory comparison between pathologic response and both histology and age was performed. On the other hand,An exploratory comparison between the three different regimens of chemotherapy was also done.

Results: Of the 85 patients, 26 (30,5%) were deemed surgical candidates after induction therapy however 7 patients of which (8,2%) refused surgery, were 27/85 males and 2/10 females had good downstaging P value (0.0001) and (0.0003) respectively with T downstaging 20/85 (23.5%), and N downstaging 18/85 (21.2%) but T+N downstaging was seen in only 9 patients (10.6%)P value (0,0001).The response to induction chemotherapy was 30/85 patients (35.2%) with one patient only (1.2%)` in a complete response . furthermore, 26/85 patients were in objective response (30.5%) and while 3 patients (3,5%) had a stable disease.Regarding responders' age, there were 18/48 patients (37%) aged 60 years and less, and only 8/37 patients (21.6%) were over 60 years.Depending on response to histology, 21/58 patients (34.5%) of SCC had got a response to preoperative chemotherapy, P value (0,0015), while 10/27 patients (37%) had no SCC,P value ( 0,0295).50/85 patients (58.8%) treated by (Gemcitabine / Cisplatin) protocol with 15 responders( 30%) P value (0,0197 ),24/85 patients (28.2%) treated with (Vinorlbine / Cisplatin) protocol with 11 responders (45.8%) P value(0.0125) . And finally,11/85 of pts (12,9%) treated by (docetaxel / cisplatin) protocol showed four responders (36.4%) P value ( 0,0332 ).

Conclusion: The preoperative chemotherapy gives a good response for a possible surgery in patients with stages IIIA and IIIB NSCLC. this response was better in patients under 60 years , P value ( 0,0055 ). With response was better seen in Vinorelbine and Cisplatin arm . However , regarding histology based response, there was no preference.the former results lead us to use neoadjuvant chemotherapy in locally advanced NSCLC,but we still need a larger trials to reach the best protocol.

Background: Non-small cell lung cancer (NSCLC), primarily including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, accounts for approximately 80% - 85% of all lung cancers, and approximately two-thirds of NSCLC patients are found to have advanced-stage disease at diagnosis (1,3).

The standard of care for the initial treatment of these patients is a platinum-based, two-drug chemotherapy (2). However, its therapeutic effect is limited and the prognosis of patients with advanced NSCLC remains poor(3,4).