Long-Term Results of the International Adjuvant Lung Cancer Trial Evaluating Adjuvant Cisplatin-Based Chemotherapy in Resected Lung Cancer

Abstract

PURPOSE Based on 5-year or shorter-term follow-up data in recent randomized trials, adjuvant cisplatin-based chemotherapy is now generally recommended after complete surgical resection for patients with non-small-cell lung cancer (NSCLC). We evaluated the results of the International Adjuvant Lung Cancer Trial study with three additional years of follow-up. PATIENTS AND METHODS Patients with completely resected NSCLC were randomly assigned to three or four cycles of cisplatin-based chemotherapy or to observation. Cox models were used to evaluate treatment effect according to follow-up duration. Results The trial included 1,867 patients with a median follow-up of 7.5 years. Results showed a beneficial effect of adjuvant chemotherapy on overall survival (hazard ratio [HR], 0.91; 95% CI, 0.81 to 1.02; P = .10) and on disease-free survival (HR, 0.88; 95% CI, 0.78 to 0.98; P = .02). However, there was a significant difference between the results of overall survival before and after 5 years of follow-up (HR, 0.86; 95% CI, 0.76 to 0.97; P = .01 v HR, 1.45; 95% CI, 1.02 to 2.07; P = .04) with P = .006 for interaction. Similar results were observed for disease-free survival. The analysis of non-lung cancer deaths for the whole period showed an HR of 1.34 (95% CI, 0.99 to 1.81; P = .06). CONCLUSION These results confirm the significant efficacy of adjuvant chemotherapy at 5 years. The difference in results beyond 5 years of follow-up underscores the need for the long-term follow-up of other adjuvant lung cancer trials and for a better identification of patients deriving long-term benefit from adjuvant chemotherapy.

Post-operative Treatment with Cisplatin and Vinorelbine in Chinese Patients with Non-small Cell Lung Cancer: A Clinical Prospective Analysis of 451 Patients

“…On the other hand, platinum-based chemotherapy is effective for patients with NSCLC in American and European countries. The IALT (International Adjuvant Lung Trial) shows that platinum-based chemotherapy for patients with NSCLC improves a 5-year survival rate by 4.1% (Arriagada et al, 2004), but there is no significant benefit after follow-up for 90 months (Arriagada et al, 2010). The CALGB 9633 trial results in a similar finding (Strauss et al, 2008).…”

Tratamento adjuvante em câncer de pulmão de células não pequenas

“…Conversely, in two other studies, the combination of cisplatin and the vinca alkaloid vinorelbine was used. (12,13) Unlike the study conducted by Arriagada et al, (11) those two other studies produced promising results: an improvement in survival was confirmed after a long follow-up period. In another study, (14) this improvement was 11% after more than nine years of follow-up, which is in disagreement with the findings of the Arriagada et al study.…”

“…However, the results of a study conducted more recently by the same group of authors (11) revealed an increase in the mortality rate after a five-year median follow-up period. Therefore, the initial improvement in survival lost statistical power, with a benefit of 3.9% (p = 0.10).…”

“…In another study, (14) this improvement was 11% after more than nine years of follow-up, which is in disagreement with the findings of the Arriagada et al study. (11) In addition, in a recent meta-analysis, (15) extremely positive results were obtained with the cisplatinvinorelbine combination, with a reduction in the overall mortality rate of 8.9% in comparison with observation (hazard ratio [HR] = 0.80; 95% CI: 0.70-0.91; p < 0.001). That analysis used data from four clinical trials, collectively involving 1,888 patients.…”

Prognostic Factors for Lymph Node Negative Stage I and IIA Non-small Cell Lung Cancer: Multicenter Experiences

“…Cisplatin based adjuvant chemotherapy can reduce the recurrence risk but there is no consensus in decision of adjuvant chemotherapy in lymph node negative early stage I and IIA NSCLC patients. IALT trial demonstrated the 4% survival advantage at 5 year but this has not been continued at 7 year follow-up in stage II and III NSCLC patients (Arriagada et al, 2010). JBR.10 trial reported survival advantage for resected NSCLC patients over 9 years of follow-up .…”