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OncoLink Library > Journal Scans > Lung Cancer

Cisplatin-Based Adjuvant Chemotherapy in Patients with Completely Resected Non-Small-Cell Lung Cancer

Reviewer: Keith Cengel, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 8, 2004

Authors: The International Adjuvant Lung Cancer Trial Collaborative Group
Source: New England Journal of Medicine (2004) Volume 350, Issue 4, Pages 351-360

Introduction

In the United States, lung cancer accounted for an estimated 171,900 new cancer diagnoses and 157,200 deaths from cancer in 2003. Despite continuing development of new therapies, the prognosis for the majority of patients diagnosed with non-small cell lung cancer (NSCLC) remains poor. Even with potentially curative resection of small, localized NSCLC lesions, approximately 30% of patients will go on to die from either locally recurrent or metastatic disease. Therefore, there has been tremendous interest in using post-operative chemotherapy in attempts to eradicate any remaining microscopic deposits of disease. A NSCLC Collaborative Group meta-analysis published in 1995 concluded that the post-operative use of alkylating agents in patients with NSCLC showed an absolute detriment of chemotherapy of 5% at 5 years. However, cisplatin-containing regimens showed a trend toward increased survival (50% to 55% at 5 years) that failed to reach statistical significance. The current study was therefore designed to evaluate the effect of cisplatin-based adjuvant chemotherapy on survival after complete resection of NSCLC.

Methods

Patients with completely resected NSCLC were randomly assigned to receive either to three or four cycles of post-operative cisplatin-based chemotherapy or to observation alone. Because of uncertainty regarding the optimal cisplatin-containing regimen, each sponsoring institution was allowed to select a single combination of cisplatin (ranging from 80 mg/m2 x 4 cycles to 120 mg/m² x 3 cycles) with either weekly vindesine (3 mg/m²/day), weekly vinblastine (4 mg/m²/day), weekly vinorelbine (30 mg/m²/day) or Etoposide (100 mg/m²/day, given on days 1 and 3 with cisplatin). In addition, each center determined the pathological stages to include and its postoperative radiotherapy policy. The main end point was overall survival.