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Comparative Study
. 2019 Feb;157(2):743-753.e3.
doi: 10.1016/j.jtcvs.2018.09.098. Epub 2018 Oct 10.

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis

Whitney S Brandt  1 , Wanpu Yan  1 , Jian Zhou  1 , Kay See Tan  2 , Joseph Montecalvo  3 , Bernard J Park  1 , Prasad S Adusumilli  1 , James Huang  1 , Matthew J Bott  1 , Valerie W Rusch  1 , Daniela Molena  1 , William D Travis  3 , Mark G Kris  4 , Jamie E Chaft  4 , David R Jones  5
Affiliations
Comparative Study

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis

Whitney S Brandt et al. J Thorac Cardiovasc Surg. 2019 Feb.

Abstract

Objective: Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non-small cell lung cancer has not been extensively studied.

Methods: Patients with cT2-4N0-1M0 non-small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan-Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.

Results: In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.

Conclusions: Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non-small cell lung cancer who undergo complete surgical resection.

Keywords: adjuvant chemotherapy; neoadjuvant chemotherapy; non–small cell lung cancer; propensity-matched analysis; survival.

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Conflict of interest statement

Conflicts of interest:

J.E.C. has received consulting fees from AstraZeneca, Merck, Genentech, and BMS and research funding from AstraZeneca, Genentech, and BMS. M.G.K. has received consulting fees from AstraZeneca, Pfizer, and Regeneron. W.D.T. has served in a nonpaid consulting role for Genentech. All other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
CONSORT diagram. NSCLC, non-small cell lung cancer; PET, positron emission tomography.
Figure 2.
Figure 2.
Five-year disease-free survival (A) and overall survival (B) for the neoadjuvant versus adjuvant group using the propensity-matched cohort. Chemo, chemotherapy.
Figure 3.
Figure 3.
Five-year disease-free survival and overall survival by RECIST response (A, B), major pathologic response (C, D), and ypStage (E, F). CR, complete response; path, pathologic; PD, progressive disease; PR, partial response; SD, stable disease.
Central Picture:
Central Picture:
Five-year disease-free survival for the neoadjuvant versus adjuvant group.
See this image and copyright information in PMC

Comment in

References

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