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Adjuvant Chemotherapy for Early-Stage Non-small Cell Lung Cancer*

Antonio L. Visbal, MD; Natasha B. Leighl; Ronald Feld, MD; Frances A. Shepherd, MD
Author and Funding Information

*From the Department of Medical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, ON, Canada.

Correspondence to: Natasha B. Leighl, 5-222, 610 University Ave, Toronto ON, M5G 2M9 Canada; e-mail: Natasha.Leighl@uhn.on.ca



Chest. 2005;128(4):2933-2943. doi:10.1378/chest.128.4.2933
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Lung cancer is the leading cause of cancer-related mortality in the developed world. Non-small cell lung cancer (NSCLC) represents 85% of cases of lung cancer, and patients have a poor 5-year survival rate. Approximately one third of NSCLC patients present with early-stage disease that is amenable to potentially curative resection and multimodality therapy. Several randomized trials now have confirmed the survival benefit with adjuvant platinum-based chemotherapy, as seen in the 1995 meta-analysis from the NSCLC Collaborative Group. The International Adjuvant Lung Cancer Collaborative Group Trial demonstrated a 4.5% improvement in survival for patients with stage I to III NSCLC. Studies from Japan have reported an improvement of 15.4% in the 5-year survival rate among patients with T1N0 disease after they had received adjuvant therapy with a combination of platinum and uracil-tegafur, and an improvement in the 5-year survival of 11% rate favoring chemotherapy with uracil-tegafur in a subgroup analysis of patients with T2N0 disease. Two recently published metaanalyses have estimated a relative risk reduction in mortality of 11 to 13% at 5 years. Significant improvement in the long-term survival rate has been demonstrated for patients with stage IB and II disease by the Cancer and Leukemia Group B 9633 trial (4-year survival rate, 12%) and the The National Cancer Institute of Canada Clinical Trials Group BR.10 trial (5-year survival rate, 15%; risk reduction for recurrence, 40%). Thus, there is compelling evidence to now recommend adjuvant platinum-based combination chemotherapy for patients after resection of early-stage NSCLC.


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