Individualizing adjuvant therapy for early stage non-small cell lung cancer: we see the destination, but we don’t yet know the route

Though the survival benefit of adjuvant therapy for at least stage II-IIIA non-small cell lung cancer (NSCLC) has been demonstrated in multiple prospective randomized phase III trials, we should recognize that our approach to post-operative management of early stage NSCLC is relatively primitive. In hopes of curing more patients, we recommend a challenging, toxic therapy to all fit patients, despite understanding that many should already be cured with no further therapy. Moreover, we can readily appreciate that platinum-based doublet therapy is far more effective for some patients than for others and that, as we have now entered an era of molecularly-guided oncology treatment, specific targeted therapies may be far superior to conventional chemotherapy for prospectively identified populations.