Postop chemotherapy supported for stage III NSCLC

By Lynda Williams, Senior medwireNews Reporter

Study findings challenge the belief that preoperative chemotherapy is superior to postoperative chemotherapy for patients with clinical stage III non-small-cell lung cancer (NSCLC).

The research, published in TheAnnals of Thoracic Surgery, includes data for 1356 patients who received chemotherapy before lobectomy or pneumonectomy for stage III clinical N2 tumours and 649 patients who received chemotherapy after their operation.

After a median follow-up of 76 months, 5-year survival was achieved by a comparable 47% of patients given preoperative chemotherapy and 42% of those given postoperative regimens, report Daniel Boffa and colleagues, from Yale University in New Haven, Connecticut, USA.

Patients who received radiation as well as preoperative chemotherapy did, however, have a higher 5-year rate of overall survival than those treated after surgery with chemoradiation (44 vs 32%).

Overall survival was then assessed in multivariate analysis adjusting for confounding factors, including age, race, comorbidity, geographical and demographical factors such as education level and distance from facility, and tumour characteristics of grade, site and type of surgery.

Again, preoperative and postoperative chemotherapy options, with or without radiation, were equal (hazard ratio [HR]=1.05), and no significant difference was detected between preoperative chemotherapy plus radiation versus postoperative chemotherapy with radiation.

The researchers note that the clinical N2 population includes patients who are accurately staged and those who are likely overstaged with N0 or N1 disease. To assess the impact of chemotherapy timing on true N2 patients, the team examined records for 1217 patients with confirmed pathological N2 disease.

In multivariate analysis, 5-year survival was significantly higher in pathological N2 patients given postoperative chemotherapy than surgery only (HR=0.73) but no further benefit was derived from radiation.

The benefit here of postoperative chemotherapy “compares extremely well with the historical trials that established preoperative chemotherapy as the standard of care”, the researchers note.

Unable to identify a “superior” approach for timing chemotherapy for this patient population, Boffa et al therefore conclude: “Further study in this area is warranted because flexibility in chemotherapy timing could be advantageous in highly selected subsets of patients with [clinical] stage III–N2 NSCLC.”

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