Chimiothérapie adjuvante des cancers bronchiques non à petites cellules : quelle chimiothérapie ? Pour quels malades ?

A meta-analysis ten years ago showed a modest non-statistically significant benefit for cisplatin-based chemotherapy in the adjuvant setting following resection of non-small cell lung cancer. Since then, several trials have evaluated this strategy. The IALT study measured the impact of cisplatin-based therapy, in association with a range of other agents versus observation and concluded positively, showing a modest but statistically significant improvement in survival. By contrast, the Italian ALPI study using MVP was negative. In the past two years, three major studies have been presented with clear positive results. Two of them, based on a Navelbine-cisplatin combination demonstrated very positive results in stages II and IIIA. A US study was positive in stage IB using Taxol and Carboplatin, in contrast to the Navelbine-cisplatin trials. Finally, the use of UFT, an oral fluoropyrimidine in Japan has also shown benefit in several trials confirmed by a meta-analysis. Based on the present recent trials, Navelbine-cisplatin should be considered after resection of stages II and IIIA NSCLC to improve the prognosis of those patients.