The place of excision repair cross complementation 1 (ERCC1) in surgically treated non-small cell lung cancer

Platinum-based regimens are the cornerstones of therapy in adjuvant and neoadjuvant management of early stage non-small cell lung cancer (NSCLC). However, the survival benefit associated with platinum-based chemotherapy is marginal and therefore adequate patient selection is essential. Excision repair cross complementation 1 (ERCC1) is a key-enzyme in the repair of platinum-DNA adducts that has been demonstrated to influence the response to platinum-based therapy. We performed a systematic review of the literature from 1996 to September 2007 on studies that assessed the role of ERCC1 in resected NSCLC. Overall, nine studies were identified. ERCC1 expression has been assessed by mRNA expression (n = 5) and/or by protein expression (immunohistochemistry) (n = 5). One study assessed ERCC1 status by both methods. In these studies, patients with early stage NSCLC treated by surgery alone survived longer if ERCC1 levels are high (favourable prognostic value of high ERCC1 level). Conversely, patients treated by surgery and who receive chemotherapy, either as adjuvant therapy or for disease relapse, have a better overall survival when ERCC1 levels are low (favourable predictive value of low ERCC1 level). ERCC1 expression might assist in selecting patients who will respond to adjuvant (neoadjuvant) platinum-based chemotherapy. However, further investigation is necessary in order to prospectively confirm these results and to ascertain the most appropriate method of assessment. Thoracic surgeons should participate in this field of research.