Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group

Pignon, Jean-Pierre; Tribodet, Hélène; Scagliotti, Giorgio Vittorio; Douillard, Jean Yves; Shepherd, Frances A.; Stephens, Richard; Dunant, Ariane; Torri, Valter; Rosell, Rafael; Seymour, Lesley; Spiro, Stephen; Rolland, Estelle; Fossati, Roldano; Aubert, D.; Ding, Keyue; Waller, David; Chevalier, Thierry Le

doi:10.1200/jco.2007.13.9030

Cited by 2,139 publications

(1,658 citation statements)

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“…The magnitude of the benefit in the current study (HR, 0.82) is comparable to that observed in clinical studies (HR, 0.89). 10 We further noted that this association varied by AJCC stage and time period of diagnosis. Carboplatin was the primary platinum agent used in the adjuvant setting and the combination of carboplatin and paclitaxel These rates may be underestimated due to our use of registry and administrative data, which do not capture the reasons patients may not be eligible for AC.…”

Section: Discussionmentioning

confidence: 65%

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

Williams

Gajra

Ganti

et al. 2014

Cancer

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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.

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Section: Discussionmentioning

confidence: 65%

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

Williams

Gajra

Ganti

et al. 2014

Cancer

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“…Chemotherapy, specifically platinum-based regimens, have been proven beneficial to survival after lobectomy in patients with more advanced stage NSCLC, especially those with lymph node spread. The Lung Adjuvant Cisplatin Evaluation meta-analysis analyzed data from the five largest RCTs investigating cisplatin-based regimens after complete resection and found a 5-year absolute survival benefit of 5.4% with adjuvant chemotherapy (31). However, this benefit varied considerably with stage; the meta-analysis showed that the majority of the survival benefit came from treating stage II (HR, 0.83; 95% CI, 0.73-0.95) and stage III (HR, 0.83; 95% CI, 0.72-0.94) NSCLCs, whereas patients with stage IA tumors (<3 cm in size; HR, 1.40; 95% CI, 0.95-2.06) had worse outcomes when treated with adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (.2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy).Measurements and Main Results: Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively.Conclusions: PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

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“…Platinum-based adjuvant chemotherapy is mostly used for these patients. Studies presented that the platinum-based chemotherapy can decrease mortality by 11% and improve five year survival by 5.4% (Pignon et al, 2008). However, patients respond differently to platinum drugs (Bahland Falk, 2001).…”

Section: Introductionmentioning

confidence: 99%

Expression of ERCC1, MSH2 and PARP1 in Non-small Cell Lung Cancer and Prognostic Value in Patients Treated with Platinum-based Chemotherapy

Xie

He²,

Sun³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Purpose: To evaluate the prognostic value of the expression of excision repair cross-complementation group l (ERCC1), MutS protein homolog 2 (MSH2) and poly ADP-ribose polymerase 1 (PARP1) in non-small-cell lung cancer patients receiving platinum-based postoperative adjuvant chemotherapy. Methods: Immunohistochemistry was applied to detect the expression of ERCC1, MSH2 and PARP1 in 111 cases of non-small cell lung cancer paraffin embedded surgical specimens. Through og-rank survival analysis, we evaluated the prognostic value of the ERCC1, MSH2, PARP1 and the related clinicopathological factors. COX regression analysis was used to determine whether ERCC1, MSH2 and PARP1 were independent prognostic factors. Results: In the enrolled 111 non-small cell lung cancer patients, the positive expression rate of ERCC1, MSH2 and RARP1 was 33.3%, 36.9% and 55.9%, respectively. ERCC1 (P<0.001) and PARP1 (P=0.033) were found to be correlated with the survival time while there was no correlation for MSH2 (P=0.298). Patients with both ERCC1 and PARP1 negative cancer had significantly longer survival time than those with ERCC1 (P=0.042) or PARP1 (P=0.027) positive alone. Similalry, the survival time of patients with both ERCC1 and PARP1 positive cancer was shorter than those with ERCC1 (P=0.048) or PARP1 (P=0.01) positive alone. Conclusion: Patients with ERCC1 or PARP1 negative non-small cell lung cancer appear to benefit from platinum-based postoperative adjuvant chemotherapy.

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Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group

Abstract: Postoperative cisplatin-based chemotherapy significantly improves survival in patients with NSCLC.

Cited by 2,139 publications

References 34 publications

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

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

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Expression of ERCC1, MSH2 and PARP1 in Non-small Cell Lung Cancer and Prognostic Value in Patients Treated with Platinum-based Chemotherapy

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