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Adjuvant Chemotherapy for Resectable Non-Small-Cell Lung Cancer

In an international trial, adjuvant chemotherapy had an absolute benefit of 4% over no chemotherapy.

Although surgically treated patients with non-small-cell lung cancer (NSCLC) often receive adjuvant chemotherapy, clinical trials have not demonstrated convincing benefits. In a partially industry-funded international trial, researchers sought to clarify the role of adjuvant chemotherapy.

Nearly 1900 patients with NSCLC (stages I, II, or III) who had undergone complete surgical resection were randomized to receive either postoperative adjuvant chemotherapy (with cisplatin plus a second drug, usually etoposide or vinorelbine) or no chemotherapy. Individual study centers had latitude in determining drug dosing, choice of second drug, and whether to add postoperative radiotherapy. Median follow-up was 56 months.

Compared with controls, chemotherapy recipients had significantly higher rates of 5-year overall survival (44.5% vs. 40.4%) and 5-year disease-free survival (39.4% vs. 34.3%). Seven patients (0.8%) died from chemotherapy toxicity. Chemotherapy was associated with longer survival regardless of whether radiotherapy was used (given to a minority of patients in each group).

Comment: On the basis of these results, an editorialist concludes that cisplatin-based adjuvant chemotherapy represents "a new standard of care" for patients with resected NSCLC. The absolute benefit (only 4%) seems small, but the authors note that it is similar to that of adjuvant chemotherapy for breast or colon cancers -- cancers for which adjuvant chemotherapy is used widely. In new studies, researchers are examining outcomes with so-called neoadjuvant therapy (chemotherapy or radiotherapy given before surgical resection).

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 13, 2004

Citation(s):

The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004 Jan 22; 350:351-60.

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• Medline abstract (Free)

Blum RH. Adjuvant chemotherapy for lung cancer -- A new standard of care. N Engl J Med 2004 Jan 22; 350:404-5.

• Original article (Subscription may be required)
• Medline abstract (Free)