ADJUVANT CHEMOTHERAPY FOT RESECTED NSCLC

1. CHEMOTHERAPY FOR RESECTED NON-SMALL-CELL LUNG CANCER
Ozioma Njoku (P2434932)
Faculty of Health and Life Science. De Montfort university , Leicester
Background
Objectives
Method
Discussion
Results
Conclusion
Acknowledgement
References
Lung cancer is the leading cause of cancer related mor-
tality in the world Molina et al, (2008). About 85% of all
lung cancers are non-small cell type.
After initial diagnosis, accurate staging of non-small-cell
lung cancer (NSCLC) using computed tomography (CT)
scan or positron emission tomography (PET) scan is
crucial for determining the appropriate therapy to be
given Molina et al, (2008).
Adjuvant chemotherapy plays a significant role in the
treatment of resected NSCLC patients as surgery either
by lobectomy, wedge resection, segmentectomy or
pneumonectomy remains the basic treatment for pa-
tients with localized NSCLC.
Patients with stages I-IIIA NSCLC are at risk for recur-
rence and death even after surgical resection.
The development of active cisplatin based combination
and completion of clinical trials assessing the activity of
adjuvant chemotherapy for resected NSCLC. Chemo-
therapy is to improve the survival status in patients with
completely resected stage II-IIIA NSCLC, which is the
aim of this study. It has been well established that its
benefits translates into 4%-5% absolute increase in
5years survival according to the published meta-
analysis Artal et al, (2014).2010
This study is deduced from the article ‘’Early stage and
locally advanced (non-metastatic) non-small-cell-lung
cancer: ESMO Clinical Practice Guidelines for diagno-
sis, treatment and follow-up’’ published in the journal of
Annals of Oncology by Crino et al, (2010).
Meta-analysis of 4584 stage I-IIIA patients using
 Five (5) large randomised trials
 Pooled from individual data bases (ALPI,
ANITA, BLT, IALT and JBR10)
 Patients assigned to 3or 4 cycles of cisplatin
based chemotherapy or to observation arm
 To examine the role of cisplatin based adju-
vant chemotherapy in completely resected
NSCLC.
Chemotherapy significantly improved 4-5year surviv-
al benefit of NSCLC patients with II-IIIA metastases.
The findings of my critique; the article was clearly
written with structured methods that allowed the au-
thors to carefully support other works carried out on
the purpose of finding an answer to the hypothesis
‘’what is the survival benefit of adjuvant chemothera-
py in completely resected stage I-IIIA NSCLC?’’. The
data pooled from the five large randomised clinical
trials are helpful and it provides valuable information
on the clinical trials independently.
Crino et al, (2010) has drawn a number of authors in
order to support their work including the key work on
non-small-cell lung cancer diagnosis and treatment
by BMJ. (1995).
The result and interpretations are blended together
but there are several limitations such as the author
did not mention the cycles and days of administra-
tion of cisplatin regime as well as provide the data on
the selected individuals for both trial and observation
arms. Also, the population of elderly patients repre-
sents just 10% of the clinical trials. Survival increase
is restricted to cases in which there is involvement of
lymph nodes Artal et al, (2014).
Finally, side effects of chemotherapy have been a
concern with neutropenia topping the chart. Hence, it
must be important to note that toxicity tends to be
transient and solved a few months after adjuvant
chemotherapy has been completed Artal et al, (2014).
Special thanks to my dedicated teachers Dr. Abu-
Median and Mr. Peter Chimkupete, for their guid-
ance and supervision.
Chemotherapy in non-small cell lung cancer: a meta-
analysis using updated data on individual patients
from 52 randomised clinical trials (1995). Bmj, 311
(7010), pp. 899.
ARTAL CORTÉS, et al,(2015) Adjuvant chemotherapy
in non-small cell lung cancer: state-of-the-art. Trans-
lational Lung Cancer Research, 8 (2), pp. 595.
CRINÒ, L. et al. (2010) Early stage and locally ad-
vanced (non-metastatic) non-small-cell lung cancer:
ESMO Clinical Practice Guidelines for diagnosis,
treatment and follow-up. Annals of Oncology : Offi-
cial Journal of the European Society for Medical Oncol-
ogy, 25 Suppl 9 (Supplement 9), pp. v559.
JEAN-PIERRE PIGNON et al. (2008) Lung Adjuvant
Cisplatin Evaluation: A Pooled Analysis by the LACE
Collaborative Group. Journal of Clinical Oncology, 22
(21), pp. 3552-3559.
MOLINA, J.R. et al. (2008) Non-Small Cell Lung Can-
cer: Epidemiology, Risk Factors, Treatment, and Sur-
vivorship. Mayo Clinic Proceedings, 83 (5), pp. 584-
594.
The recognition that adjuvant chemotherapy can
improve survival after surgery for non-small-cell
lung cancer represents a tremendouds advance in
lung cancer treatment Pignon et al, (2008). More
specifically is the administration of cisplatin based
doublet chemotherapy after complete resection
and it has been associated with a 5years survival
increase.
Given the heterogeneity of the trials, several meta-
analysis have been reported to combine the re-
sults Artal et al, (2014). The LUNG Adjuvant Cispla-
tin Evaluation (LACE) meta-analysis is the most
important Pignon et al, (2008); Artal et al, (2014). In
all the studies cisplatin-based doublets were used
Crino et al, (2010). The drugs given with 80 mg/m2
cisplatin dose in 4 cycles were mainly vinorelbine
30mg/m2
per day and the benefit was consistent
across the trial for stage I-IIIA.
The result from the regimens confirmed that adju-
vant cisplatin-based doublet chemotherapy in-
crease survival from 64%-67% for stage IB, from
39%-49% for stage II and from 26%-39% for stage
III NSCLC Crino et al, (2010).
The rationale for adjuvant chemotherapy in pa-
tients with NSCLC is that distant metastases are
the most common site of failure potentially cura-
tive surgery.
With a median follow-up of 5.2 years, overall hazard
ratio for death was 0.89 shown in (fig.1) correspond-
ing to a 5 year absolute benefit of 5.4% derived from
chemotherapy Artal et al, (2014).
Results contd
Fig.1 overall survival by trial
Pignon JP, et al. ASCO 2006. Abstract 7008