How to personalize perioperative chemotherapy in early non-small cell lung cancer?

Abstract

Disseminated micrometastatic disease often limits the effectiveness of aggressive locoregional treatment strategies in operable non-small cell lung cancer (NSCLC). The perioperative chemotherapy (neo- and adjuvant chemotherapy) results in a minimal survival advantage and is associated with a significant toxicity in a subgroup of patients. A proportion of early-stage patients are cured by local treatment modality alone and associated systemic treatment ends in a possible overtreatment, while in other patients, with the same pathological stage, systemic treatment is not effective at all. Therefore, there is a critical need to individualize systemic treatment in early-stage NSCLC. When treatment personalization is considered, two are the main goals: from one side, to reduce toxicity and, on the other, to improve efficacy outcomes. Currently new prospective trials for early stage are ongoing. In these studies patients are randomized to experimental treatment with cytotoxic or targeted agents that are customized by molecular pathways, genomic characterization, and/or immunological targets. Hopefully, awaited results from these trials will provide us new information for the management of stages I–III NSCLC.