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Cisplatin-based chemo improves post-op survival in NSCLC
Last Updated: 2008-08-18 16:38:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) - After complete resection of non-small cell lung cancer (NSCLC), there is a significant improvement in survival when cisplatin-based chemotherapy is administered, according to results of a meta-analysis involving more than 4,500 patients.
The Lung Adjuvant Cisplatin Evaluation (LACE) Collaborative Group pooled data from the five largest trials conducted since 1995 of cisplatin-based chemotherapy, involving a total of 4,584 NSCLC patients who had undergone complete resection. Median follow-up time was 5.2 years.
The overall hazard ratio (HR) of death was 0.89, which corresponded to a five-year absolute survival benefit of chemotherapy of 5.4%, Dr. Jean-Pierre Pignon of Institut Gustave-Roussy in Villejuif, France, and colleagues report in the July 20 issue of the Journal of Clinical Oncology.
Benefit varied with stage, ranging from a HR of 1.40 for stage IA to a HR of 0.83 for stage III. "After exclusion of the small numbers of stage IA patients, there was no significant variation of chemotherapy effect according to stage," the investigators found.
"A significant increase of chemotherapy effect with better performance status was observed, and our data suggest that chemotherapy may be detrimental for patients with a performance status of 2," Dr. Pignon's team reports. Thus, at this time, adjuvant cisplatin-based chemotherapy cannot be recommended for these patients."
Survival was not significantly affected by any particular drug used in combination with cisplatin, the intended total cisplatin dose, whether radiotherapy was planned or not, type of surgery, histology, age or sex.
"Our analysis clearly confirms that adjuvant cisplatin-based chemotherapy is of benefit in completely resected NSCLC and further supports its use in routine clinical practice," the LACE Collaborative Group says.
"Interactions between tumor markers and chemotherapy effect have been shown in individual trials, and the LACE group is undertaking a collaborative project to validate these findings," Dr. Pignon and associates add.
J Clin Oncol 2008;26:3552-3556.
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