Adjuvant Chemotherapy for Resected Non‐Small Cell Carcinoma of the Lung: Why We Still Don't Know

Abstract

The role of adjuvant chemotherapy in resected non‐small cell carcinoma of the lung (NSCLC) remains controversial. A critical review of the 11 cisplatin‐based randomized trials addressing this issue was performed using methodology adapted from the CONSORT statement. The 11 trials were divided into those that included predominantly node‐negative patients (n = 5) and those that included predominantly node‐positive patients (n = 6). In the node‐negative trials, which included 1,084 evaluable patients, no evidence of heterogeneity of treatment effect between the trials was found. The composite five‐year survival rate for chemotherapy patients was 61% versus 55% for control patients, which reached marginal significance (p = 0.06). In the node‐positive trials, which included 880 evaluable patients, a marginal lack of homogeneity of treatment effect between trials was found (p = .013). The composite two‐year survival rate for chemotherapy patients was 48% versus 40% for control patients, which reached marginal significance (p = 0.06). Although not definitive, these trials suggest a benefit to postoperative adjuvant chemotherapy in resected NSCLC. The cumulative experience of the 11 trials is notable for: A) the small number of patients; B) heterogenous patient populations; C) substandard chemotherapy regimens; D) inadequate chemotherapy delivery, and E) less than optimally executed clinical trials. The 11 trials are discussed in detail, and recently completed and ongoing trials of adjuvant chemotherapy in resected NSCLC are reviewed.

Cancer Care Ontario and American Society of Clinical Oncology Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non–Small-Cell Lung Cancer Guideline

“…Literature search results. The systematic review conducted by members of CCO's Lung DSG identified eight meta-analyses, 4,[12][13][14][15][16][17][18][19][20][21][22] and 16 RCTs involving intravenous platinum-based chemotherapy [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] relevant to this guideline. Detailed summaries of the trial characteristics and results have been published elsewhere.…”

Adjuvant Cisplatin and Vinorelbine for Completely Resected Non-small Cell Lung Cancer: Subgroup Analysis of the Lung Adjuvant Cisplatin Evaluation

“…Several meta-analyses including newer cisplatin-based regimens showed a small but consistent effect on survival. [5][6][7][8][9] The more recent Lung Adjuvant Cisplatin Evaluation (LACE) 10 is a meta-analysis based on individual patient data from the five largest adjuvant trials of cisplatin-based adjuvant chemotherapy published after 1995. [11][12][13][14][15][16][17] LACE showed a HR of 0.89 for death (95% confidence interval ͓CI͔: 0.82-0.96, p ϭ 0.004) corresponding to an absolute survival benefit of 5.4% at 5 years, in agreement with the 1995 meta-analysis.…”

Problem Penegakkan Diagnostik Pasien dengan Massa di Paru

“…28 Data menunjukkan pemberian adjuvant kemoterapi dapat meningkatkan massa hidup 5 tahun meningkat 5% dibandingkan dengan hanya pembedahan saja dan tidak didapatkan perbedaan yang bermakna antara pemberian dengan cisplatin dan carboplatin dan juga pemberian 2 siklus atau 4 siklus. 29,30 Pada penderita ini diberikan adjuvant kemoterapi dengan platinum base paxus-carboplatin selama 4 siklus.…”