Adjuvant Chemotherapy in Completely Resected Non–Small-Cell Lung Cancer

2005 ◽  
Vol 23 (14) ◽  
pp. 3270-3278 ◽  
Author(s):  
Katherine M.W. Pisters ◽  
Thierry Le Chevalier
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Trials ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Risk Of Death ◽  
Resected Nsclc

Surgery alone has long been the standard treatment for patients with operable non–small-cell lung cancer (NSCLC). However, despite complete resection, 5-year survival rates have been disappointing, with about 50% of patients eventually suffering relapse and death from disease. Randomized trials conducted in the 1980s hinted at a survival benefit for postoperative cisplatin-based regimens, but they were underpowered. A meta-analysis published in 1995 found a nonsignificant 13% reduction in the risk of death associated with cisplatin-based chemotherapy, with an increase of survival of 5% at 5 years. This led to renewed interest in adjuvant chemotherapy in resected NSCLC. Thousands of patients have been included in a new generation of randomized trials in the last 10 years. Most of these recent studies have now been reported and several have demonstrated a clear survival advantage for patients treated with platin-based adjuvant therapy. These results also suggest a greater benefit with modern two-drug regimens. In view of the most recent data, postoperative platin-based chemotherapy can now be considered the standard of care for completely resected NSCLC patients with good performance status.

Age and Comorbidity As Independent Prognostic Factors in the Treatment of Non–Small-Cell Lung Cancer: A Review of National Cancer Institute of Canada Clinical Trials Group Trials

2008 ◽  
Vol 26 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Timothy R. Asmis ◽  
Keyue Ding ◽  
Lesley Seymour ◽  
Frances A. Shepherd ◽  
Natasha B. Leighl ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Trials ◽  
Demographic Data ◽  
Performance Status ◽  
Dose Intensity ◽  
Small Cell ◽  
Comorbid Conditions ◽  
Small Cell Lung

Purpose This study analyzed patients enrolled in two large, prospectively randomized trials of systemic chemotherapy (adjuvant/palliative setting) for non–small-cell lung Cancer (NSCLC). The main objective was to determine if age and/or the burden of chronic medical conditions (comorbidity) are independent predictors of survival, treatment delivery, and toxicity. Patients and Methods Baseline comorbid conditions were scored using the Charlson comorbidity index (CCI), a validated measure of patient comorbidity that is weighted according to the influence of comorbidity on overall mortality. The CCI score (CCIS) was correlated with demographic data,(ie, age, sex, race), performance status (PS), histology, cancer stage, patient weight, hemoglobin, alkaline phosphatase, lactate dehydrogenase, outcomes of chemotherapy delivery (ie, type, total dose, and dose intensity), survival, and response. Results A total of 1,255 patients were included in this analysis. The median age was 61 years (range, 34 to 89 years); 34% of patients were elderly (at least 65 years of age); and 31% had comorbid conditions at randomization. Twenty-five percent of patients had a CCIS of 1, whereas 6% had a CCIS of 2 or greater. Elderly patients were more likely to have a CCIS equal to or greater than 1 compared with younger patients (42% v 26%; P < .0001), as were male patients (35% v 21%; P < .0001) and patients with squamous histology (36% v 29%; P = .001). Although age did not influence overall survival, the CCIS appeared prognostic (CCIS 1 v 0; hazard ratio 1.28; 95%CI, 1.09 to 1.5; P = .003). Conclusion In these large, randomized trials, the presence of comorbid conditions (CCIS ≥ 1), rather than age more than 65 years, was associated with poorer survival.

scholarly journals Does the Couse of Astragalus-Containing Chinese Herbal Prescriptions and Radiotherapy Benefit to Non-Small-Cell Lung Cancer Treatment: A Meta-Analysis of Randomized Trials

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Hailang He ◽  
Xianmei Zhou ◽  
Qian Wang ◽  
Yang Zhao
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
White Blood Cells ◽  
Small Cell ◽  
Small Cell Lung ◽  
Risk Of Death ◽  
Chinese Herbal

Background.Radiotherapy has been widely used for non-small-cell lung cancer (NSCLC), while its low efficacy and high toxicity raise big concerns. Astragalus (as a monarch drug)-containing Chinese herbal prescriptions and radiotherapy were frequently coused for NSCLC in China; however, the effects were not systematically analyzed.Objective.To evaluate the benefits of Astragalus-containing Chinese herbal prescriptions combined with radiotherapy for NSCLC.Methods.The randomized controlled trials involving NSCLC treatment with Astragalus-containing Chinese herbal prescriptions combined with radiotherapy were searched. The Review Manager 5.1 software was employed for data analysis. Funnel plot and Egger’s test were applied to evaluate publication bias.Results.29 eligible studies met our criteria. Of the studies, 8, 6, and 4 reported reduced risk of death at one year, two years, and three years, respectively. 26 studies revealed amended tumor response. Six studies showed improved Karnofsky performance status. Among the studies, 14 and 18 displayed a lowered white blood cells (WBC) toxicity and an ameliorated radiation pneumonia, respectively.Conclusion.Couse of Astragalus-containing Chinese herbal prescriptions and radiotherapy may benefit the patients with NSCLC via increasing the therapeutic effectiveness and reducing the toxicity of radiotherapy. To confirm the exact merits, further rigorously designed trials are warranted.

scholarly journals Adoption of Adjuvant Chemotherapy for Non–Small-Cell Lung Cancer: A Population-Based Outcomes Study

2010 ◽  
Vol 28 (21) ◽  
pp. 3472-3478 ◽  
Author(s):  
Christopher M. Booth ◽  
Frances A. Shepherd ◽  
Yingwei Peng ◽  
Gail E. Darling ◽  
Gavin Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Adjuvant Chemotherapy ◽  
General Population ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Substantial Improvement ◽  
Small Cell ◽  
Small Cell Lung ◽  
Resected Nsclc

Purpose Since 2004, several clinical trials have demonstrated that adjuvant chemotherapy (ACT) improves survival in patients with early-stage non–small-cell lung cancer (NSCLC). Here, we evaluate the uptake of ACT and its impact on outcomes in the general population of Ontario, Canada. Methods All patients diagnosed with NSCLC in Ontario from 2001 to 2006 who underwent surgical resection (n = 6,304) were identified using the Ontario Cancer Registry. We linked electronic records of treatment to the registry. We described uptake of ACT and compared survival of all patients with surgically resected NSCLC diagnosed from 2001 to 2003 with patients diagnosed from 2004 to 2006. As a proxy measure of ACT-related toxicity, we evaluated hospitalizations within 6 months of surgery. Results Demographic, disease, and treatment-related characteristics did not differ between the 2001 to 2003 and 2004 to 2006 study cohorts. Over the study period, the proportion of patients receiving ACT increased from 7% (192 of 2,950 patients) to 31% (1,032 of 3,354 patients; P < .001). The proportion of patients admitted to hospital within 6 months of surgery remained stable and (36% in the 2001 to 2003 cohort and 37% in the 2004 to 2006 cohort). However, within 2 years of surgery, there was a 33% reduction in the proportion of patients admitted to hospital with metastatic disease (P < .001). During the study period, there was a substantial improvement in 4-year survival among surgically resected patients, from 52.5% (2001 to 2003) to 56.1% (2004 to 2006; P = .001). Conclusion There has been a rapid uptake of ACT for NSCLC, which was not associated with an increased rate of hospitalization. The adoption of ACT was associated with a substantial improvement in overall survival, suggesting that the benefits seen in clinical trials are generalizable to the general population.

scholarly journals Clinical benefits of adjuvant chemotherapy with carboplatin and gemcitabine in patients with non-small cell lung cancer: a single-center retrospective study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Shinogu Takashima ◽  
Kazuhiro Imai ◽  
Maiko Atari ◽  
Tsubasa Matsuo ◽  
Katsutoshi Nakayama ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Propensity Score Analysis ◽  
Performance Status ◽  
Area Under The Curve ◽  
Small Cell ◽  
Small Cell Lung ◽  
Clinical Benefits

Abstract Purpose In cases of non-small cell lung cancer (NSCLC), surgery remains the best option for cure, but surgery is of benefit only when the disease is localized. Although adjuvant chemotherapy reportedly has a significant beneficial effect on survival, the benefit of a carboplatin (CBDCA) regimen is unclear. We therefore investigated the efficacy and tolerability of CBDCA (area under the curve 5) plus gemcitabine (GEM, 1000 mg/m2) as adjuvant chemotherapy. Methods A total of 82 pStage IB-IIIA NSCLC patients who had undergone complete resection and received adjuvant chemotherapy were analyzed retrospectively. Among them, 65 patients received CBDCA + GEM and 17 received CDDP + VNR. Propensity score analysis generated 17 matched pairs of both groups. Results Sixty-five patients received CBDCA + GEM. Their 5-year relapse-free survival (RFS) and overall survival were 47.8% (median, 52.5 months) and 76.9% (median, 90.1 months), respectively. Toxicities, which included neutropenia, nausea/anorexia, fatigue, and vasculitis, were significantly milder than with CDDP + VNR. There were no significant differences in RFS between CBDCA + GEM and CDDP + VNR (p = 0.079) after matching for age, performance status, and pStage. Conclusion CBDCA + GEM was effective and well tolerated as adjuvant chemotherapy, with a manageable toxicity profile.

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