By Timothy A. O'Leary
GENEVA -- April 25, 2008 -- Patients with early-stage non-small-cell lung cancer (NSCLC) who have chemotherapy before surgery are more likely to survive up to 5 years than are patients who have surgery alone, according to research presented here at the 1st European Lung Cancer Conference (ELCC).
Eric Vallières, MD, Surgical Director of the Lung Cancer Program at the Swedish Cancer Institute in Seattle, Washington, and his collaborators conducted their phase 3 study from 1999 until 2004, when they were forced to halt the study when it became standard procedure to offer postoperative chemotherapy to patients with NSCLC.
Of the 600 patients whom they had planned to enrol, they achieved a total cohort of 354, including 174 patients who were randomly assigned to the surgery-alone group and 180 in the preoperative chemotherapy group.
After 5 years, half of the patients who had received chemotherapy before surgery were alive as opposed to 43% of the patients who had received surgery alone.
Of the patients who had received chemotherapy before surgery, 42% had no sign of cancer after 5 years, compared with 32% of those who underwent surgery alone.
"Complete resection rates trended in favour of the [chemotherapy plus surgery] arm," Dr. Vallières said.
In the study, the preoperative chemotherapy regimen consisted of paclitaxel 225 mg/m2 over 3 hours, carboplatin at an area under the curve of 6 on day 1 every 3 weeks for 3 cycles.
While acknowledging the benefit to patients of postoperative chemotherapy, Dr. Vallières noted a similar benefit from preoperative chemotherapy.
"Randomised trials comparing preoperative to adjuvant chemotherapy in operable NSCLC are warranted," he said.
He had expected the group receiving preoperative chemotherapy to have pneumonectomies at a lower rate than the group receiving surgery alone, Dr. Vallières said. It surprised him that this did not happen.
"If you can do fewer pneumonectomies, you're ahead of the game," he said. "I was hoping that [preoperative chemotherapy] would result in fewer pneumonectomies. It did not. The rate of pneumonectomies in both arms was about the same at 16%."
The unexpected result is a "paradox," he said, which raises the question of whether "all these pneumonectomies were really necessary." The answer to that question is "being analysed," he added.
"A lobectomy is harder to perform than a pneumonectomy and takes longer to do," which may explain why there were more pneumonectomies than lobectomies, he said.
Dr. Vallières mentioned a particular patient who received preoperative chemotherapy followed by a lobectomy. This patient was spared from needing a pneumonectomy by receiving the chemotherapy up front, he said.
He added, "The operation that you do is the operation that [patients] need at the time of surgery."
[Presentation title: S9900 Trial of Surgery Vs Neoadjuvant Chemotherapy. Abstract 28IN]
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