Neoadjuvant chemotherapy with docetaxel in non--small cell lung cancer.

Based on proven activity and survival benefit in advanced non--small cell lung cancer, docetaxel has been introduced into neoadjuvant therapy. In a large, phase III randomized trial in 274 stage IIIA and IIIB patients, treatment with an induction regimen of 100 mg/m(2) docetaxel for three cycles before definitive surgery or radiotherapy was associated with an encouraging trend towards longer median survival. Overall 1-year survival was 59% compared with 51% in the control group. Docetaxel in the neoadjuvant setting was well tolerated and did not compromise later radical local therapy. The incidence of grade (3/4) esophagitis, for example, was less than 1% in patients who had had induction docetaxel followed by curative radiotherapy. This also was true for pneumonitis. Neoadjuvant docetaxel in combination with cisplatin or carboplatin is being evaluated in phase II trials which have reported response rates of 66% to 82% and rates of complete resection ranging from 69% to 79%. Docetaxel also is being investigated in combination with both cisplatin and gemcitabine in phase I/II studies. Phase III trials will further define the promising role of docetaxel alone and in combination in neoadjuvant therapy. Semin Oncol 28 (suppl 9):33-36.