Chemotherapy in Early Stage NSCLC Improves SurvivalAccording to results presented from two “late-breaking” clinical trials at the 40th annual meeting of the American Society of Clinical Oncology (ASCO), chemotherapy following surgery for early non-small cell lung cancer improves survival compared to surgery alone.1,2
Lung cancer remains the leading cause of cancer deaths in the United States. Non-small cell lung cancer (NSCLC) refers to the type of cell within the lung that the cancer originated and comprises the majority of cases of lung cancer. Early lung cancer refers to cancer that is confined within the lung or nearby tissue, and has not spread to distant or several sites in the body. Standard treatment for early NSCLC consists of surgery if patients are eligible to remove as much of the cancer as possible and possibly the addition of radiation and/or chemotherapy. However, survival benefits of treatment following surgery have not yet been confirmed through clinical trials until now. The addition of chemotherapy following surgery, referred to as adjuvant chemotherapy, is to kill any cancer cells that may remain in the body following surgery. The remaining cells, although often times undetectable with current screening methods, are responsible for cancer recurrences and ultimately death from the disease in patients with early stage NSCLC. The optimal adjuvant chemotherapy regimen has not yet been established, with several clinical trials currently underway to address this issue.
One trial presented at ASCO evaluating adjuvant chemotherapy was conducted by researchers affiliated with the National Cancer Institute of Canada. This trial included 482 patients with stages IB and III NSCLC who were treated between 1994 and 2001. Patients were treated with surgery plus the chemotherapy combination of vinorelbine (Navelbine®) and cisplatin (Platinol®), or surgery alone. Approximately 5 years following treatment, overall survival was 69% in the group of patients treated with adjuvant chemotherapy, compared with 54% in the group of patients treated with surgery alone. Cancer-free survival at 5 years was 61% for patients treated with adjuvant chemotherapy, compared to only 48% for those treated with surgery alone. Twelve percent of patients discontinued treatment due to side effects. The presenters stated that patients who were otherwise in good health benefited the most from adjuvant chemotherapy.
The second clinical trial presented at ASCO evaluating adjuvant chemotherapy was conducted by researchers affiliated with the Cancer and Leukemia Group B (CALGB). This trial included 344 patients who had stage IB NSCLC. Patients were treated with surgery plus the chemotherapy combination consisting of paclitaxel (Taxol®) and carboplatin (Paraplatin®) or surgery alone. Overall survival at approximately 2 years following treatment was 93% for patients treated with adjuvant chemotherapy, compared with only 84% for those treated with surgery alone. At approximately 3 years following treatment, overall survival was 82% for patients treated with adjuvant chemotherapy, compared to only 69% for those treated with surgery alone. The main side effect of chemotherapy was low levels of white blood cells.
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The researchers concluded that adjuvant chemotherapy improves survival in early NSCLC. However, they caution that patients with illnesses or health issues in addition to their lung cancer may not achieve the same benefit as their healthier counterparts. It is important for patients with early NSCLC to discuss their individual risks and benefits of adjuvant chemotherapy with their physician, as well as side effects associated with different chemotherapy regimens.
1.Winton TL, Livingston R, Johnson D, et al. A Prospective Randomised Trial of Adjuvant Vinorelbine (VIN) and Cisplatin (CIS) in Completely Resected Stage IB and II Non Small Cell Lung Cancer (NSCLC). Proceedings of the American Society of Clinical Oncology 2004;23,Late-Breaking Abstracts Booklet:17, Abstract #7018.
2.Strauss GM, Herndon J, Maddaus MA, et al. Randomized Clinical Trial of Adjuvant Chemotherapy with Paclitaxel and Carboplatin Following Resection in Stage IB Non-Small Cell Lung Cancer (NSCLC): Report of Cancer and Leukemia Group B (CALGB) Protocol 9633. Proceedings of the American Society of Clinical Oncology 2004;23,Late-Breaking Abstracts Booklet:17, Abstract #7019.
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