Examining the benefits of adjuvant chemotherapy for early-stage lung cancer

This study examined the use of adjuvant platinum-based chemotherapy in the treatment of early-stage non-small cell lung cancer.

The cornerstone of early-stage non-small cell lung cancer treatment is the surgical removal of the tumor. While additional chemotherapy treatments after surgery (referred to as adjuvant chemotherapy) were often reserved for advanced cancer patients, several recent trials have provided evidence supporting the use of adjuvant platinum-based chemotherapy for completely resected early-stage lung cancer patients. The current review analyzed evidence regarding the long-term survival benefits associated with adjuvant chemotherapy in the treatment of early-stage non-small cell lung cancer.

In a study of 1867 patients who underwent surgery for stage I-III lung cancer, platinum-based adjuvant chemotherapy led to a 4.1% increase in 5-year survival rates compared to patients who were only observed following surgery. Statistical analysis concluded that adjuvant chemotherapy was associated with a 14% reduction in the risk of early mortality. However, by 7-years following surgery no significant difference in survival was noted. Two similar trials investigated in this review also reported increased 5-year survival rates (up to 15%) with adjuvant chemotherapy use, but only among stage IB-III patients and not among stage IA patients.

A large meta-analysis (an analysis of data combined from several similar studies) including 4584 patients also found a significant survival benefit for stages II and III patients receiving adjuvant platinum-based chemotherapy, but noted no survival benefits among stage IB patients receiving adjuvant chemotherapy, and reduced survival among stage IA patients receiving adjuvant chemotherapy. In comparison, a separate, smaller, study reviewed did note that adjuvant chemotherapy led to a 31% reduction in early mortality risk among stage IB lung cancer patients whose tumors were larger than 4 centimeters.

Survival benefit with adjuvant chemotherapy may also depend on the type of cancer involved, as patients with adenocarcinomas saw a larger survival benefit compared to patients with non-adenocarcinoma type lung cancers.

The combination of the chemotherapeutic agents cisplatin and vinorelbine was noted as particularly beneficial, showing a 8.9% increase in 5-year survival rates, compared to other chemotherapy regimens. Unfortunately, the majority of patients were unable to finish treatment cycles due to severe side effects. Up to 85% of patients using this adjuvant chemotherapy combination developed neutropenia, a very low white blood cell count, leaving patients susceptible to infections.

This review concluded that adjuvant platinum-based chemotherapy can benefit long-term survival among early stage non-small cell lung cancer patients, particularly in patients with stage II or III cancers, or those with larger tumors.

Consult with your physician regarding the risks and benefits of adjuvant chemotherapy in the treatment of early stage lung cancer.