| Adjuvant chemotherapy for completely resected non-small-cell lung cancer. | |
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MedLine Citation:
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PMID: 19893597 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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For many years, surgery alone was the standard treatment for patients with stage I-IIIA non-small-cell lung cancer (NSCLC). However, recent studies have demonstrated that adjuvant chemotherapy provides a survival benefit. The first adjuvant chemotherapy for NSCLC was performed in the 1960s using a key drug known as cyclophosphamide. In the 1980s and early 1990s, a new anti-cancer drug, cisplatin, was developed. The first meta-analysis of this drug was conducted by the Non-small Cell Lung Cancer Collaborative Group in 1995. This analysis comparing surgery with surgery plus chemotherapy containing cisplatin produced a hazard ratio of 0.87 and suggested an absolute benefit of chemotherapy of 5% at 5 years;this difference was not statistically significant (p0.08). Several clinical trials of adjuvant chemotherapy were planned after the meta-analysis conducted in 1995, but the efficacy of adjuvant chemotherapy remained a matter of controversy. However, useful evidence was reported after 2003. The International Adjuvant Lung Cancer Collaborative Group Trial (IALT) demonstrated a 4.1% improvement in survival for patients with stage I to III NSCLC. The JBR. 10 trial demonstrated a 15% improvement in 5-year survival for the adjuvant chemotherapy arm in stage IB or II (excluding T3N0) patients. The Adjuvant Navelbine International Trialist Association (ANITA) trial reported that the overall survival at 5 years improved by 8.6% in the chemotherapy arm and that this survival rate was maintained at 7 years (8.4%) in stage II and IIIA patients. A meta-analysis based on collected and pooled individual patient data from the 5 largest randomized trials was conducted by the Lung Adjuvant Cisplatin Evaluation (LACE). This analysis demonstrated that cisplatin-based adjuvant chemotherapy improved survival in patients with stage II or III cancer. Alterna-tively, uracil-tegafur has been developed and tested in Japan. The Japan Lung Cancer Research Group (JLCRG) on Postsurgical Adjuvant Chemotherapy reported a 5-year overall survival advantage of 11% in the uracil-tegafur group patients with stage IB cancer. The efficacy of adjuvant chemotherapy with uracil-tegafur was confirmed in a meta-analysis. In conclusion, the results of phase III trials and a meta-analysis have confirmed the benefit of adjuvant chemotherapy for resected stage IB, II, and IIIA NSCLC. |
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Authors:
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Hiroshi Suehisa; Shinichi Toyooka |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Acta medica Okayama Volume: 63 ISSN: 0386-300X ISO Abbreviation: Acta Med. Okayama Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-11-06 Completed Date: 2009-12-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417611 Medline TA: Acta Med Okayama Country: Japan |
Other Details:
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Languages: eng Pagination: 223-30 Citation Subset: IM |
Affiliation:
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Department of Cancer, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan. hsuehisa@shikoku-cc.go.jp |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antineoplastic Agents
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therapeutic use* Carcinoma, Non-Small-Cell Lung* / drug therapy, pathology, surgery Chemotherapy, Adjuvant* Clinical Trials as Topic Humans Lung Neoplasms* / drug therapy, pathology, surgery Meta-Analysis as Topic Survival Rate Tegafur / therapeutic use Treatment Outcome Uracil / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents; 17902-23-7/Tegafur; 66-22-8/Uracil |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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