Some Lung Cancer Patients Benefit From Surgery, Chemotherapy Combination

Because of the benefits experienced by patients who received both surgery and chemotherapy to treat other cancers, researchers launched the International Adjuvant Lung Cancer Trial to study the combination treatment in patients with NSCLC.

In the first large-scale trial studying the effects of chemotherapy after surgery for the treatment of NSCLC, 1,867 lung cancer patients received either chemotherapy after surgery, or surgery alone. Those who received chemotherapy were treated with cisplatin (Platinol), plus either etoposide (VePesid), vinorelbine (Navelbine), vinblastine (Velban), or vindesine (Eldesine).

Patients who were treated with both surgery and chemotherapy were more likely to live longer and be cured of the disease than if they had been treated with surgery alone, according to study results.

The findings show that of the patients treated with chemotherapy following surgery:

• 70% were alive two years later, compared with 67% of patients treated with surgery alone.
• 45% were alive five years later, compared with 40% of patients treated with surgery alone.
• 61% were cancer free two years later, compared with 55% of patients treated with surgery alone.
• In addition, 39% of patients treated with chemotherapy following surgery were cancer free five years later, compared with 34% of patients treated with surgery alone.

Cancer is considered cured if it does not recur within five years after treatment. Researchers found that five years after treatment, there was a 5% increase in survival in patients who received both surgery and chemotherapy.

"A 5% increase in survival is significant enough to recommend chemotherapy after surgery," said Thierry Le Chevalier, MD, of the Institut Gustave Roussy in France, and lead researcher of the trial. Researchers anticipate their findings could change the standard of care for lung cancer.

In treating NSCLC, cisplatin caused some serious side effects, including a drop in white blood cells, which left some patients susceptible to infection. Other clinical trials are now evaluating whether new drugs such as gemcitabine (Gemzar) and taxanes (a group of drugs that includes paclitaxel-taxol-and docetaxel-taxotere), used in combination with surgery, may be more effective in treating NSCLC with fewer side effects.

However, for patients with NSCLC that has spread to the surrounding lymph nodes, a separate team of researchers at Loyola University Chicago's Cardinal Bernardin Cancer Center recommends that patients be treated with chemotherapy, radiation, and surgery.

In a study of 411 patients with NSCLC that had spread to the lymph nodes in the mediastinum—the area between the lungs—researchers found that the combined approach of all three treatments reduces the chance that cancer will return following treatment, and increases the amount of time patients will remain cancer free, compared to a two-step treatment of chemotherapy and radiation. Researchers also noted that both approaches are more effective than surgery or radiation alone.

"We now have two very promising treatment options to discuss with patients that offer them a better chance of curing their cancer," said lead researcher Kathy S. Albain, MD.

Patients participating in the trials received either a combination of the chemotherapy drugs cisplatin (Platinol) and etoposide (VePesid) with limited-dose radiation and then surgery, or the same chemotherapy regimen plus full-dose radiation.

The results showed:

• Patients who received the three-pronged treatment approach remained cancer free for an average of 14 months, compared with 11.7 months for those who received the two-pronged approach.
• Three years after treatment, 29% of those who received chemotherapy, radiation, and surgery were living cancer free compared with 19% of patients who had chemotherapy and radiation.
• The average survival for all patients was 22 months, significantly longer than either surgery or radiation alone.
• Overall survival three years after treatment was higher in the group that underwent surgery. Of this group, 38% of the patients were alive 3 years after the treatment, compared with 33% of those treated with only chemotherapy and radiation.

Dr. Albain cautioned that patients should be counseled by a team of doctors, including a medical oncologist, a radiation oncologist, and a thoracic surgeon, about the potential risks and benefits of both treatment approaches.

Surgery patients had a greater risk of respiratory complications after the surgery, and those treated with chemotherapy and radiation had a greater chance of severe difficulty with swallowing.

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