Adjuvant Chemotherapy for Completely Resected IIA-IIIA Non-small Cell Lung Cancer: Compliance to Guidelines, Safety and Efficacy in Real-life Practice

Overview

Journal Transl Lung Cancer Res

Date 2023 Jan 13

PMID 36636405

Authors

Anne-Laure Desage

Claire Tissot

Sophie Bayle-Bleuez

Thierry Muron

Nadine Deygas

Valerie Grangeon-Vincent

Brigitte Monange

Fatah Torche

Paul Vercherin

David Kaczmarek

Olivier Tiffet

Fabien Forest

Jean-Michel Vergnon

Wafa Bouleftour

Pierre Fournel

Affiliations

Soon will be listed here.

Abstract

Background: Since randomised clinical trials demonstrated a survival benefit of adjuvant chemotherapy (AC) following curative-intent lung surgery, AC has been implemented as a standard therapeutic strategy for patients with a completely resected IIA-IIIA non-small cell lung cancer (NSCLC). Regarding the moderate benefit of AC and the lack of literature on AC use in real-life practice, we aimed to evaluate compliance to guidelines, AC safety and efficacy in a less selected population.

Methods: Between January 2009 and December 2014, we retrospectively analysed 210 patients with theoretical indication of AC following curative-intent lung surgery for a completely resected IIA-IIIA NSCLC. The primary objective of this retrospective study was to evaluate compliance to AC guidelines. Secondary objectives included safety and efficacy of AC in real-life practice.

Results: Among 210 patients with a theoretical indication of AC, chemotherapy administration was validated in multidisciplinary team (MDT) for 62.4% of them and 117 patients (55.7%) finally received AC. Patient's clinical conditions were the main reasons advanced in MDT for no respect to AC guidelines. Most of the patients received cisplatin-vinorelbine (86.3%) and AC was initiated within 8 weeks following lung surgery for 73.5% of patients. One-half of patients who received AC experienced side effects leading to either dose-intensity modification or treatment interruption. In real-life practice, AC was found to provide a survival benefit over surgery alone. Factors related to daily-life practice such as delayed AC initiation or incomplete AC planned dose received were not associated with an inferior survival.

Conclusions: Although AC use might differ from guidelines in real-life practice, this retrospective study highlights that AC can be used safely and remains efficient among a less selected population. In the context of immunotherapy and targeted therapies development in peri-operative treatment strategies, the place of AC has to be precised in the future.

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