Chapter

Systemic therapy for early-stage NSCLC

Benjamin Besse and Jean-Charles Soria

in Systemic Treatment of Non-Small Cell Lung Cancer

Published on behalf of Oxford University Press

ISBN: 9780199580484
Published online March 2012 | e-ISBN: 9780199607532 | DOI: http://dx.doi.org/10.1093/med/9780199580484.003.0003

Series: Oxford Oncology Library

Systemic therapy for early-stage NSCLC

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• Data supporting the use of adjuvant chemotherapy are more conclusive and robust than those for induction chemotherapy, although efficacy may be comparable • Patients under 75 years, PS 0 or 1 without surgical complications were included in the peri-operative prospective trials • Cisplatin-based chemotherapy is standard in radically-resected stage II and IIIA patients • Cisplatin-based chemotherapy is optional for stage IB patients (in particular those superior to 4 cm) and is not recommended for stage IA patients • Adjuvant chemotherapy should begin within 2 months after surgery and 3 to 4 cycles are recommended (cumulative dose of cisplatin from 240 to 400 mg/m2) • Vinorelbine-cisplatin is the most validated regimen in randomized trials while carboplatin should only be favoured in case of contraindications to cisplatin.

Aggressive surgical management of non–small-cell lung cancer (NSCLC) patients results in a 5-year survival rate ranging from 73% for pathologic stage IA to 25% for stage IIIA. The survival rates for a given clinical stage are much lower than those for the corresponding surgical/pathologic stage due to the preoperative staging that often underestimates the extent of the disease (particularly if positron-emission tomography and mediastinoscopy are not used) Given these poor survival rates associated with treatment by surgery alone, the use of induction or adjuvant systemic treatment have been investigated for years. In the last individual data based (IPD) meta-analysis from IGR-MRC on adjuvant treatment, reported in 2007, a 4% absolute improvement of the 5-year survival rate (HR = 0.87; 95% CI, 0.81 to 0.93; P = 0.0000001) resulted from the analysis of data of 8,147 patients. Cisplatin-based regimen emerged as the best adjuvant chemotherapeutic option. Adjuvant chemotherapy is better validated than induction chemotherapy, although their efficacy may be comparable. The most recent meta-analysis regarding induction chemo- therapy on 1,507 patients reported a hazard ratio of 0.88 (95% CI = 0.76–1.01; P = .07).

Chapter.  4201 words. 

Subjects: Medical Oncology

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