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

Abstract

BACKGROUND Despite clinical trials demonstrating improved survival with adjuvant chemotherapy (AC) for patients with American Joint Committee on Cancer stages I to III non‐small cell lung cancer (NSCLC), it is unclear whether this survival benefit extends to broader populations. The current study evaluated patterns of AC use and examined the impact of AC on survival. METHODS A retrospective analysis was conducted of patients in the Veterans Affairs Central Cancer Registry diagnosed with stages IB to IIIA NSCLC between 2001 and 2008. Descriptive statistics were used to examine patterns of AC use over an 8‐year time period. Cox proportional hazards regression analyses were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CIs) to compare mortality risk among patients treated with and without AC. RESULTS Among 14,306 patients with stages IB to IIIA NSCLC, 4929 underwent surgery and 22% of these received AC. The percentages of patients diagnosed in 2001 through 2003, 2004 through 2005, and 2006 through 2008 receiving AC were 7.0%, 29.8%, and 29.5%, respectively. There was no survival benefit with AC noted for patients diagnosed between 2001 and 2003, but AC was associated with improved survival for the period between 2004 and 2005 (HR, 0.78; 95% CI, 0.67‐0.91) and 2006 through 2008 (HR, 0.79; 95% CI, 0.69‐0.91). Of those patients receiving AC, 89% received platinum‐doublet chemotherapy. Carboplatin remained the most common agent, although cisplatin use reached 43% in the period between 2006 and 2008. The HR for cisplatin relative to carboplatin was 0.96 (95% CI, 0.80‐1.15). CONCLUSIONS There was a significant increase in the use of AC between 2001 and 2008 and AC was associated with an improvement in overall survival. Cancer 2014;120:1939–1947. © 2014 American Cancer Society.

The Unique Spatial-Temporal Treatment Failure Patterns of Adjuvant Gefitinib Therapy: A Post Hoc Analysis of the ADJUVANT Trial (CTONG 1104)

“…1 Doublet chemotherapy (vinorelbine plus cisplatin [VP]) is a standard adjuvant treatment for resected stage II-III NSCLC. [2][3][4] Radiation therapy has a role before or after surgery for N2 patients. 5,6 Evidence of the clinical benefits of adjuvant chemotherapy for resected early-stage NSCLC has been shown in a meta-analysis demonstrating that 5-year survival rates increased by 4%.…”

Effect of age on the efficacy of adjuvant chemotherapy for resected non–small cell lung cancer

“…16 Similarly, in a database analysis of patients treated within the Veterans Affairs (VA) system, the use of adjuvant chemotherapy was associated with an 18% decreased risk of death after surgical resection in patients with stages IB to IIIA NSCLC. 17 With a median age at diagnosis of 70 years, NSCLC results in a significant disease burden among the elderly. 18 To the best of our knowledge, there are no prospective trials of adjuvant chemotherapy limited to older patients published to date.…”

Stratification of Patients With Stage IB NSCLC Based on the 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual

“…The occurrence and development of NSCLC is complex, and decisions regarding the administration of adjuvant therapy for stage IB NSCLC patients remains controversial. Some research studies have suggested that patients with stage IB NSCLC could benefit from adjuvant therapy (16)(17)(18), while other studies have reported no effects of adjuvant chemotherapy on patients (9,11,12,(19)(20)(21). Studies that have shown the benefit of adjuvant chemotherapy in stage IB patients tend to recommend adjuvant therapy for patients with tumor size ≥4 cm (7,8,12,22,23).…”