Standard treatment for lung cancer should be changed, say scientists

Patients with non-small cell lung cancer (NSCLC) are more likely to survive if they have chemotherapy after surgery than if they have surgery alone, said a scientist at ECCO 12 The European Cancer Conference in Copenhagen today (Tuesday 23 September). Dr. Bengt Bergman, of the Sahlgrenska University Hospital. Göteborg, Sweden, said that results from the International Adjuvant Lung Cancer Trial (IALT), which involved 1,867 patients in 33 countries, were sufficiently strong to recommend changing the standard treatment.

The randomised controlled trial showed an absolute 4.1% increase in survival after five years among those who had had adjuvant therapy with cisplatin, in combination with one of several other commonly-used cancer drugs. A 1995 meta-analysis of other trials showed a similar advantage for this therapy, but with only a borderline statistical significance since fewer patients with cisplatin treatment were included, said Dr. Bergman.

Recurrence of lung cancer was also reduced in the cisplatin arm of the trial. After 5 years 24% of those taking cisplatin had a local recurrence, whereas this occurred in 29% of the control arm. The study found no interaction between dose or treatment combination and survival benefit.

The trial was the first with sufficient numbers of patients to show a statistically significant survival benefit from adjuvant chemotherapy in NSCLC, said Dr. Bergman. “Although a 4.1% improvement may not seem very much on which to base recommending a change in treatment, it is in line with results from other common malignancies such as breast, ovarian, and colon cancer, where the survival gain from adjuvant chemotherapy lies in the range of 3.5 – 8%. In all these cases adjuvant treatment is now part of the routine treatment.”

However, toxicity remains a problem, he said. “There are potentially serious side effects to this treatment, and we need better tools to identify the patients who are most likely to benefit from adjuvant chemotherapy. The IALT project includes an extended research programme which aims to identify predictive tumour markers. And a planned joint analysis of the largest recent trials of adjuvant cisplatin-based therapy including more than 4,000 patients will better enable us to detect factors allowing us to predict treatment effects.”

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