Adjuvant chemotherapy for completely resected IIA–IIIA non-small cell lung cancer: compliance to guidelines, safety and efficacy in real-life practice

Abstract

Background: Since randomised clinical trials demonstrated a survival benefit of adjuvant chemotherapy (AC) following curative-intent lung surgery, AC has been implemented as a standard therapeutic strategy for patients with a completely resected IIA-IIIA non-small cell lung cancer (NSCLC). Regarding the moderate benefit of AC and the lack of literature on AC use in real-life practice, we aimed to evaluate compliance to guidelines, AC safety and efficacy in a less selected population.Methods: Between January 2009 and December 2014, we retrospectively analysed 210 patients with theoretical indication of AC following curative-intent lung surgery for a completely resected IIA-IIIA NSCLC. The primary objective of this retrospective study was to evaluate compliance to AC guidelines.Secondary objectives included safety and efficacy of AC in real-life practice.Results: Among 210 patients with a theoretical indication of AC, chemotherapy administration was validated in multidisciplinary team (MDT) for 62.4% of them and 117 patients (55.7%) finally received AC. Patient's clinical conditions were the main reasons advanced in MDT for no respect to AC guidelines.Most of the patients received cisplatin-vinorelbine (86.3%) and AC was initiated within 8 weeks following lung surgery for 73.5% of patients. One-half of patients who received AC experienced side effects leading to either dose-intensity modification or treatment interruption. In real-life practice, AC was found to provide a survival benefit over surgery alone. Factors related to daily-life practice such as delayed AC initiation or incomplete AC planned dose received were not associated with an inferior survival.Conclusions: Although AC use might differ from guidelines in real-life practice, this retrospective study highlights that AC can be used safely and remains efficient among a less selected population. In the context of immunotherapy and targeted therapies development in peri-operative treatment strategies, the place of AC has to be precised in the future.

Adjuvant chemotherapy for locally advanced non-small cell lung cancer: still state of the art or an outdated therapy?

“…For patients undergoing curative-intent lung surgery with severe comorbidities, AC is frequently omitted. Comorbidities were an independent factor for non-compliance to the guidelines of AC in the study of Désage et al ( 6 ). This patient population is underrepresented in studies.…”

“…Age was the most crucial factor for non-guideline-based AC in the study of Désage et al ( 6 ). Interestingly, discontinuation or dose reduction did not differ significantly between patients older- and younger than 70 years.…”

“…Désage et al performed a multi-center retrospective analysis of 588 patients who underwent curative-intent lung surgery between 2009 and 2014. In fact, 210 patients had a theoretical indication of AC ( 6 ). The study’s primary endpoint was to determine compliance with AC guidelines in real-life practice and to observe if AC was delayed for any reason ( 6 ).…”

“…In fact, 210 patients had a theoretical indication of AC ( 6 ). The study’s primary endpoint was to determine compliance with AC guidelines in real-life practice and to observe if AC was delayed for any reason ( 6 ). Furthermore, the authors examined which patient population deviated the most from guideline-based AC.…”

“…According to guidelines, AC should be initiated within 4-8 weeks following lung surgery ( 1 ). Désage et al demonstrated that postoperative complications, length of stay in the hospital exceeding 14 days, and an early referral to a rehabilitation unit were independent factors for the delay of the administration of AC ( 6 ).…”