A.2 Tratamiento NEOADYUVANTE

Lucia Santomé, Centro Médico POVISA

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A.2. TRATAMIENTO NEOADYUVANTE

A.2.1. FASES III RANDOMIZADOS:

Varios ensayos realizados en la década de los 90 demostraron un beneficio en la supervivencia con el empleo de quimioterapia neoadyuvante, sin embargo posteriores estudios, con mayor número de pacientes, no llegaron a las mismas conclusiones. Mencionar que hay que tener en cuenta la heterogeneidad de pacientes reclutados, así como tamaño muestral y empleo de tratamiento adyuvante, lo que explica los resultados contradictorios.

A continuación se recogen los ensayos fase III más significativos:

  1. Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994;86(9):673.
    http://www.ncbi.nlm.nih.gov/pubmed/8158698
  2. Roth JA, Atkinson EN, Fossella F, et al. Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. Lung Cancer.1998;21(1):1.
    http://www.ncbi.nlm.nih.gov/pubmed/9792048
  3. Rosell R, Gomez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med 1994;330:153-158.
    http://www.ncbi.nlm.nih.gov/pubmed/8043059
  4. Rosell R, Gómez-Codina J, Camps C, et al. Preresectional chemotherapy in stage IIIA non-small-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung Cancer. 1999; 26(1):7.
    http://www.ncbi.nlm.nih.gov/pubmed/10574676
  5. Scagliotti G, Pastorino U, Vansteenkiste J et al. Randomized phase III of surgery alone or surgery plus preoperative cisplatin and gemcitabine in stages IB to IIIA non-small cell lung cancer. J Clin Oncol 2011; 30(2):172-178.
    http://www.ncbi.nlm.nih.gov/pubmed/22124104
  6. Depierre A, Milleron B, Moro-Sibilot D, et al, French Thoracic Cooperative Group. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer. J Clin Oncol. 2002;20(1):247.
    http://www.ncbi.nlm.nih.gov/pubmed/11773176
  7. Katherine M.W. Pisters, Eric Vallie`res, John J. Crowley , et al. Surgery With or Without Preoperative Paclitaxel and Carboplatin in Early-Stage Non–Small-Cell Lung Cancer: Southwest Oncology Group Trial S9900, an Intergroup, Randomized, Phase III Trial. J Clin Oncol 2010;28:1843-1849.
    http://www.ncbi.nlm.nih.gov/pubmed/20231678

A.2.2. META-ANÁLISIS Y REVISIONES SISTEMÁTICAS:

Dado que la eficacia de la supervivencia con la quimioterapia neoadyuvante no está clara, a partir de los estudios publicados se realizaron revisiones sistemáticas y meta-análisis para intentar esclarecer esta cuestión.

    1. Berghmans T, Paesmans M, Meer AP, et al. Survival improvement in respectable non-small lung cancer with (neo)adyuvant chemotherapy: results of meta-analysis of the literature. Lung Cancer 2005; 49(1):13-23
      http://www.ncbi.nlm.nih.gov/pubmed/15949586
    2. Burdett SS, Stewart LA, Rydzewska L: Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev (3): CD006157, 2007.
      http://www.ncbi.nlm.nih.gov/pubmed/17636828
    3. Gilligan D, Nicolson M, Smith I, et al. Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet. 2007 Jun 9; 369(9577):1929-37.
      http://www.ncbi.nlm.nih.gov/pubmed/17544497
    4. Song WA, Zhou NK, Wang W, et al. Survival Benefit of Neoadjuvant Chemotherapy in Non-small Cell Lung Cancer: An Updated Meta-Analysis of 13 Randomized Control Trials. J Thoracic Oncology: April 2010 – Volume 5–Issue 4 – pp 510-516.