TY - JOUR T1 - Update on nonsmall cell lung cancer JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 173 LP - 185 DO - 10.1183/09059180.00006610 VL - 19 IS - 117 AU - G. Zalcman AU - E. Bergot AU - E. Lechapt Y1 - 2010/09/01 UR - http://err.ersjournals.com/content/19/117/173.abstract N2 - Despite recent advances and declining its incidence in males in Western countries, lung cancer remains the main cause of cancer deaths worldwide, mainly because of tobacco smoking epidemics in developing countries and the still moderate efficacy of therapeutic strategies [1–3]. More than 80% of lung cancers are nonsmall cell lung cancer (NSCLC), which can be further sub-divided into squamous cell carcinoma (SCC), adenocarcinoma and large cell carcinoma (LCC). Metastatic stage IV NSCLC remains an incurable disease with a median survival that reached a plateau of 8–10 months at the beginning of the century with available cisplatinum-based regimens [4].In stage I to III NSCLC, the occurrence of extrathoracic metastasis also leads to a poor 5-yr survival rate of 50% [5]. Indeed, NSCLC has a high metastasis potential, and is often drug resistant, so even after early diagnosis and resection with curative intent, patient prognosis remains poor [6]. Efforts have been made to improve overall survival (OS) of early NSCLC patients, by lowering the distant metastasis rate with adjuvant or neoadjuvant chemotherapy. The LACE (Lung Adjuvant Cisplatin Evaluation) meta-analysis of adjuvant cisplatinum-based chemotherapy only found a 5-yr absolute benefit of 5.4% (hazard ratio (HR) 0.89; p = 0.004) restricted to stage II and III patients, and 5-yr OS remained below 60% [7]. However, in the IALT (International Adjuvant Lung Cancer Trial) study, the benefit was lost at 7 yrs, because of an excess of non-cancer deaths in the chemotherapy arm [8]. Conversely, the long-term follow-up in the ANITA (Adjuvant Navelbine International Trialist Association) trial, using a more recent vinorelbine-cisplatinum doublet strategy, showed that the chemotherapy arm benefit was maintained at 7 yrs [9]. Two meta-analyses [10, 11] of neoadjuvant chemotherapy trials also … ER -