Related Pages Lung Cancer Home Page NCI's gateway for information about lung cancer. Highlights from ASCO 2003 A collection of links to material summarizing some of the important clinical trial results announced at the 2003 annual meeting of the American Society of Clinical Oncology (ASCO).

Key Words: chemotherapy, lung cancer, surgery. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)

Summary
A large international study has shown that patients with the most common form of lung cancer - non-small cell lung cancer, or NSCLC – may live longer if they are treated with chemotherapy after surgery. These results may justify post-operative chemotherapy for NSCLC patients in otherwise good health.

Source
American Society of Clinical Oncology (ASCO) annual meeting, Chicago, June 2, 2003.(The final results were subsequently published in the Jan. 22, 2004, issue of the New England Journal of Medicine. See the journal abstract.)

Background
Non-small cell lung cancer (NSCLC) accounts for 80 percent of all lung cancer cases. Tumors can be surgically removed in one-third of patients. The average five-year survival rate is about 50 percent for patients whose NSCLC is found early and treated with surgery, before it has spread to other organs. The five-year survival rate for all stages of non-small cell lung cancer combined is 15 percent.

A 1995 analysis of pooled data from several clinical trials concluded that adjuvant (after surgery) chemotherapy might improve five-year survival by 5 percent in patients with lung cancer that is surgically removable. The current study was performed to confirm that conclusion in a large phase III randomized clinical trial.

The Study: Between 1995 and 2000, the International Adjuvant Lung Cancer Trial enrolled 1,867 patients from 148 centers in 33 countries. Thirty-six percent of the participants had stage I non-small cell lung cancer cancer, 25 percent had stage II, and 39 percent had stage III -- but all had cancer that was surgically removable. All patients were treated with surgery, though the extent of surgery varied. Sixty-four percent of patients had at least one lobe of the lungs removed (lobectomy); 35 percent had either the left or right lung entirely removed (pneumonectomy).

Half of the patients were randomly assigned to receive chemotherapy after surgery; the other half were treated with surgery alone. Some patients also received chest radiotherapy after surgery. The exact post-surgical regimen varied depending on each center’s current standard treatment, though the chemotherapy used by all the centers was based on cisplatin combined with one other agent (either etoposide or a vinca alkaloid) at a prespecified dose. The authors used statistical methods to analyze these differences in determining whether or not cisplatin-based chemotherapy conferred any survival advantage over surgery alone. (See the protocol summary.)

Results
Five years after treatment, 44.5 percent of the patients treated with post-surgical chemotherapy were still alive, compared with 40.4 percent of the patients treated with surgery alone. Survival free of disease was also better for patients who got chemotherapy. Five years after treatment, 39.4 percent of those patients were free of disease, compared with 34.3 percent of the patients who received surgery alone.

Cisplatin caused some serious side effects, including a drop in the number of white blood cells, which leaves patients susceptible to infection. Studies are now under way to test other chemotherapy regimens containing drugs that may offer the same survival benefit as cisplatin with fewer adverse effects, said Thierry Le Chevalier, M.D., of the Institut Gustave Roussy in France, who was the lead investigator for the study.

“Our findings support offering adjuvant chemotherapy to all [patients whose lung cancer has been surgically removed],” Le Chevalier concluded.

Limitations
The gains noted by this study were statistically significant, but patients should be carefully selected for this approach because of the additional toxicity associated with chemotherapy.

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