Adjuvant chemotherapy for completely resected IIA-IIIA non-small cell lung cancer: compliance to guidelines, safety and efficacy in real-life practice

Abstract

Background: Since randomised clinical trials demonstrated a survival benefit of adjuvant chemotherapy (AC) following curative-intent lung surgery, AC has been implemented as a standard therapeutic strategy for patients with a completely resected IIA-IIIA non-small cell lung cancer (NSCLC). Regarding the moderate benefit of AC and the lack of literature on AC use in real-life practice, we aimed to evaluate compliance to guidelines, AC safety and efficacy in a less selected population.

Methods: Between January 2009 and December 2014, we retrospectively analysed 210 patients with theoretical indication of AC following curative-intent lung surgery for a completely resected IIA-IIIA NSCLC. The primary objective of this retrospective study was to evaluate compliance to AC guidelines. Secondary objectives included safety and efficacy of AC in real-life practice.

Results: Among 210 patients with a theoretical indication of AC, chemotherapy administration was validated in multidisciplinary team (MDT) for 62.4% of them and 117 patients (55.7%) finally received AC. Patient's clinical conditions were the main reasons advanced in MDT for no respect to AC guidelines. Most of the patients received cisplatin-vinorelbine (86.3%) and AC was initiated within 8 weeks following lung surgery for 73.5% of patients. One-half of patients who received AC experienced side effects leading to either dose-intensity modification or treatment interruption. In real-life practice, AC was found to provide a survival benefit over surgery alone. Factors related to daily-life practice such as delayed AC initiation or incomplete AC planned dose received were not associated with an inferior survival.

Conclusions: Although AC use might differ from guidelines in real-life practice, this retrospective study highlights that AC can be used safely and remains efficient among a less selected population. In the context of immunotherapy and targeted therapies development in peri-operative treatment strategies, the place of AC has to be precised in the future.

Keywords: Adjuvant chemotherapy (AC); non-small cell lung cancer (NSCLC); real-life practice.

Figure 1

Flow chart presenting the selection process of the cohort study. *, patients whose medical record was not available were not included in the selection process. Patients who underwent thoracic surgery for either benign lung lesion, thymoma resection or solitary pleural fibroma were also excluded from the selection process. MDT, multidisciplinary team.

Figure 2

Compliance to AC guidelines. (A) Main reasons for no AC validation in MDT. (B) AC regimen prescribed. (C) Delay of initiation of AC. (D) Total number of AC cycles received. Median and interquartile range (25^th–75^th) are represented by the black line. Dots represent patients who received AC. Patients for whose cisplatin-vinorelbine was switched for other chemotherapy regimen (n=3) were not included in this analysis. (E) Number of AC cycles received without dose reduction or omission. Median and interquartile range (25^th–75^th) are represented by the black line. Dots represent patients who received AC. Patients for whose cisplatin-vinorelbine was switched for other chemotherapy regimen (n=3) were not included in this analysis. AC, adjuvant chemotherapy; MDT, multidisciplinary team.

Figure 3

DFS (A) and OS (B) of AC in real-life practice. DFS, disease-free survival; OS, overall survival; AC, adjuvant chemotherapy.

Figure 4

Impact of delayed AC (A) and the number of complete AC cycles received without dose reduction or omission (B) on OS. AC, adjuvant chemotherapy; OS, overall survival.