Adjuvant Treatment of Resected Lung Cancer

Abstract

Lung cancer is the leading cause of cancer mortality worldwide, and efforts to improve outcomes of patients with this disease require a multidisciplinary approach. While surgical resection is the optimal treatment for early stage lung cancer, the high rates of recurrence after resection pose a distinct challenge. In recent years, substantial evidence has accumulated to support adjuvant chemotherapy in Stage II and III non-small cell lung cancer (NSCLC). A recent meta-analysis of large clinical trials of cisplatin-based adjuvant chemotherapy for resected NSCLC showed that the 5-year survival benefit in favor of chemotherapy was 5.3% (hazard ratio for death, 0.89; 95% confidence interval, 0.82-0.96; P = 0.005). The use of adjuvant chemotherapy in Stage I NSCLC remains controversial. Current and future efforts are being directed toward identification of prognostic and predictive markers to select patients at highest risk for recurrence, and of chemotherapeutic agents to which their tumors are most likely to respond. The role of targeted therapies, including those directed at the epidermal growth factor receptor and vascular endothelial growth factor in adjuvant treatment, is currently under investigation. At this time, there are no data to support the routine use of adjuvant radiation treatment, except in cases in which surgical margins are positive.

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

“…3 The goal of postoperative adjuvant chemotherapy (AC) is to reduce the risk of disease recurrence by eliminating residual disease that may persist after surgical resection, and thus improve survival. A landmark meta-analysis published in 1995 demonstrated a statistically nonsignificant trend in survival benefit associated with cisplatin-based AC compared with those patients treated with surgery alone, and an absolute survival benefit of 4% at 5 years.…”

MutS Homologue 2 and the Long-term Benefit of Adjuvant Chemotherapy in Lung Cancer

“…Possible unexplained late chemotherapyrelated mortality and other factors may be involved (8). The results emphasize the importance of long-term follow-up of patients enrolled in clinical trials and translational studies (41).…”

“…A comprehensive view of all these predictors is needed together with a validation of the most interesting ones on other completed trials. The most promising markers will be incorporated in future trials to select patients unlikely to benefit from conventional platinumbased therapies and to which new agents that are active in advanced stages of lung cancer can be proposed in the adjuvant setting (41). In our opinion, expression of genes that are directly involved in the repair of cisplatin-DNA adducts such as MSH2 and ERCC1 as well as genes involved in cell events that are required for DNA repair to occur, including genes involved in cell cycle arrest such as P27 and DNA damage response genes, should be tested in priority in future trials.…”

VATS lobectomy facilitates the delivery of adjuvant docetaxel-carboplatin chemotherapy in patients with non-small cell lung cancer

“…Accrual of patients in this study occurred at an unusually rapid pace compared to other recent trials involving adjuvant therapy after resection of NSCLC with curative intent (6-10). In fact, several important adjuvant trials have been halted due to poor patient accrual (6,16). This efficient enrollment was accomplished via the participation of the CCTC, an organization recently formed to advance fully ICH-GCP compliant clinical research at leading cancer centers in China.…”