Preoperative Chemotherapy Improves Survival in NSCLC

Pre-operative (neoadjuvant) chemotherapy for non-small cell lung cancer (NSCLC) is associated with a significant reduction in the risk of death, according to the results of a meta-analysis published in The Lancet.

Lung cancer remains the leading cause of cancer-related deaths worldwide. In the United States, NSCLC accounts for 75–80% of all lung cancers. For patients with lung cancer that can be surgically removed, several studies have addressed the benefit of post-surgery (adjuvant) chemotherapy as well as pre-operative (neoadjuvant) chemotherapy.

To evaluate the benefit of neoadjuvant chemotherapy, researchers performed a meta-analysis that included data from 15 eligible randomized controlled trials involving a total of 2,385 patients.

The analysis revealed a significant improvement in overall survival among patients who received neoadjuvant therapy—specifically a 13 percent reduction in the risk of death. This represents an absolute survival improvement of 5 percent at five years, from 40 percent to 45 percent. What’s more, there was no evidence that effects differed as a result of the type of chemotherapy or number of agents used. In addition, age, performance status, gender, histology, stage, and use of postoperative radiotherapy did not seem to impact the effect of neoadjuvant therapy.

Recurrence-free survival and time to distant recurrence were significantly improved with the use of neoadjuvant chemotherapy. Five-year recurrence free survival improved from 30 percent to 36 percent with the use of neoadjuvant chemotherapy. There was also a non-significant improvement in time to locoregional recurrence among patients who received neoadjuvant chemotherapy.

The researchers concluded that neoadjuvant chemotherapy significantly improves overall survival, recurrence-free survival, and time to distant recurrence in resectable NSCLC.

Reference:

NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small cell lung cancer: a systematic review and meta-analysis of individual participant data. The Lancet. Published early online February 25, 2014. doi:10.1016/S0140-6736(13)62159-5

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