Adjuvant Chemotherapy Improves Non–Small Cell Lung Cancer Survival
Among patients with operable non–small cell lung cancer, the addition of chemotherapy to surgery modestly improves survival. These results were published in Lancet.
Lung cancer remains the leading cause of cancer-related deaths worldwide. In the United States, non–small cell lung cancer (NSCLC) accounts for 75–80% of all lung cancers.
For patients with lung cancer that can be surgically removed, several studies have addressed the benefit of post-surgery (adjuvant) chemotherapy. In order to summarize all available information about the benefit of adjuvant chemotherapy, researchers conducted combined analyses of previously published studies.
The first analysis compared treatment with surgery alone to treatment with surgery and chemotherapy. This analysis included information from 34 trial comparisons and 8,447 patients. The results indicated that the addition of chemotherapy provided a 4% absolute increase in survival (five-year survival increased from 60% to 64%).
The second analysis compared treatment with surgery and radiation to treatment with surgery, radiation, and chemotherapy. This analysis included information from 13 trial comparisons and 2,660 patients. Once again, the addition of chemotherapy provided a 4% absolute increase in survival (five-year survival increased from 29% to 33%).
These results confirm that adjuvant chemotherapy improves survival among patients with operable non–small cell lung cancer. Uncertainties remain, however, about the effect of chemotherapy among patients with Stage I cancer, particularly Stage IA. An editorial that accompanies this study notes, “Adjuvant platinum-based chemotherapy can be recommended for patients who have complete resection of stage II-III NSCLC and have uncomplicated recovery with good performance status within 3 months of surgery. Treatment can be considered for patients with larger tumours (T2b, T3) without lymph-node involvement. The scarcity of data means adjuvant treatment cannot be recommended for patients with stage IA disease.”
 NSCLC Meta-analyses Collaborative Group. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet[early online publication]. March 24, 2010.
 Kalemkerian GP. Adjuvant therapy for non-small cell lung cancer. Lancet [early online publication]. March 24, 2010.
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