According to a recent article published in the New England Journal of Medicine, chemotherapy used following surgery-referred to as adjuvant therapy-improves survival in patients with early-stage non-small cell lung cancer (NSCLC).

Lung cancer remains the leading cause of cancer-related deaths in the United States. NSCLC, named for the type of cell within the lung where the cancer originated, is the most common type of lung cancer. Patients diagnosed with early lung cancer (cancer that is confined to its site of origin) are often treated with surgery to remove as much cancer as possible. Unfortunately, while all detectable cancer may be surgically removed, undetectable cancer cells may remain in the body. These cells are responsible for cancer recurrence and fatalities experienced by a large portion of patients with operable NSCLC. The purpose of adjuvant chemotherapy is to kill cancer cells that may be remaining in the body following surgery. Until now, the benefits of adjuvant therapy in patients with operable NSCLC have not been clear, as not all clinical trials evaluating adjuvant therapy have demonstrated a benefit. However, more recent clinical trials with newer regimens have demonstrated a greater benefit with adjuvant therapy than older studies, suggesting that new chemotherapy agents may indeed improve outcomes in patients with operable NSCLC.

Researchers from Canada conducted a clinical trial to evaluate the effectiveness of the chemotherapy combination consisting of cisplatin (Platinol®) and vinorelbine (Navelbine®) following surgery in patients with stages IB-II NSCLC. Stages IB and II NSCLC cancers are either confined to the lung in which they originated or have spread to nearby lymph nodes. This trial included 482 patients who underwent surgery, and were then treated with cisplatin/vinorelbine or received no further treatment (control group). The average overall survival was higher in the group treated with chemotherapy-93 months compared with 73 months in the control group. At 5 years, the overall survival rate was greater for the group treated with chemotherapy as well-69 percent with only 54 percent in the control group. Furthermore, the survival rate with no evidence of cancer recurrence at 5 years was more than 10 percent higher for the chemotherapy group (61 percent versus 49 percent). Two patients died from treatment in the chemotherapy group.

The researchers concluded that results of this trial confirm that adjuvant chemotherapy improves outcomes, including survival, in patients with operable, early-stage NSCLC and should be considered the new standard of care. Patients with early-stage NSCLC may wish to speak with their physician regarding their individual risks and benefits of adjuvant chemotherapy.

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Reference: Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small cell lung cancer. The New England Journal of Medicine 2005;351:2589-2597.

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