Recommendations on adjuvant therapy for patients with early stage non-small-cell lung cancer

This article presents updated guidelines on treating non-small cell lung cancer patients with adjuvant (following surgery) chemotherapy or radiation. The authors provide recommendations on when to use adjuvant therapy based primarily on disease stage.

Cancer patients who have tumors removed by surgery often undergo further treatment. This is called adjuvant therapy and generally includes either chemotherapy or radiation. The American Society of Clinical Oncology (ASCO) has provided guidelines that recommend how to treat patients with adjuvant therapy. The guidelines make it clear when to include adjuvant therapy, for what type of cancer and what stage.

This review summarizes updates of the ASCO guidelines based on recent clinical trials and studies. The recommendations presented by the authors focus on patients with stage I to IIIA non-small-cell lung cancer (NSCLC) that have had tumors removed surgically.

For patients with stage IA cancer, adjuvant chemotherapy is not recommended as the side effects outweigh the benefit.

For patients with stage IB cancer, adjuvant chemotherapy is not strongly recommended however there are other factors clinicians should consider. Other factors include tumor size.  Patients who have had larger tumors removed had a higher risk of recurrence and could therefore benefit from further treatment. Types of tumors are also a factor.  Patients with solid tumors could benefit from further treatment as they have worse prognosis than those with minimally invasive tumors. The genetic profile of the patient needs to be considered. Cancer with specific genetic mutations (changes) may not be improved by adjuvant chemotherapy.

For patients with stage IIA/B and IIIA adjuvant chemotherapy is recommended as the benefit outweighs the side effects.

For patients with stage IA/B and IIA/B, adjuvant radiation therapy is not recommended as the harm outweighs the benefit.

For patients with stage IIIA cancer, adjuvant radiation therapy is not routinely recommended. Patients with cancer that has spread, however, are advised to undergo an evaluation with a radiation oncologist. 

The authors of this review outlined updated recommendations on treating cancer patients with adjuvant chemotherapy of radiation therapy.