Neo-adjuvant (pre-operative) chemotherapy does not improve survival chances of patients with resectable non-small cell lung cancer compared with surgery alone. The findings are reported early Online and in an upcoming edition of The Lancet, timed to coincide with presentation of the paper at the American Society of Clinical Oncology meeting in Chicago.
And an accompanying comment says that surgery should not be delayed through using neo-adjuvant chemotherapy; it recommends that chemotherapy should take place after surgery (adjuvant chemotherapy).
Richard Stephens, Medical Research Council Clinical Trials Unit, London, UK and colleagues studied 519 patients from 70 centres in the UK, Netherlands, Germany and Belgium.
Most patients were clinical stage I (61%), with 31% stage II and 7% stage III. The researchers found that although nearly half (49%) of the patients responded well to neo-adjuvant chemotherapy and 31% experienced downgrades in their clinical staging, there was no benefit in terms of overall survival.
The authors say however, that the hazard ratios (relative safety) of neo-adjuvant versus adjuvant therapy are similar, and that the different techniques could be used to target different subgroups of patients.
They say: “Neo-adjuvant chemotherapy might best be used when tumours need down-staging pre-operatively, or where existing comorbities could make recovery from surgery slower and so delay the optimum administration of [post-operative] chemotherapy.”
Combining the result of this trial with previous trials suggests use of neo-adjuvant chemotherapy results in a relative increase survival benefit of 12% and an absolute survival benefit of 5% at five years.
The authors conclude: “Although there was no evidence of a difference in overall survival with neo-adjuvant chemotherapy, the result is statistically consistent with previous trials, and therefore adds considerable weight to the current evidence.”
In an accompanying comment, Dr Frances Shepherd and Dr Penelope Bradbury, University Health Network, Princess Margaret Hospital and University of Toronto, Ontario, Canada, say: “While a systematic review indicates a potential benefit from preoperative chemotherapy, the body of evidence to date favours postoperative chemotherapy.
“We recommend that surgery, the most important component of combined modality treatment for early stage non-small cell lung cancer, not be delayed, and that systemic treatments should be administered postoperatively.”
Journal
The Lancet