Adjuvant chemotherapy is underutilized in clinical practice, in part, because its
anticipated survival benefit is limited. We evaluated the impact of AC on overall
and recurrence-free survival among completely resected pN1 NSCLC patients enrolled
in the North American Intergroup phase III (JBR10) trial. A post-hoc subgroup analysis
of pN1 NSCLC patients was performed. Participants were randomized to cisplatin+vinorelbine
(AC) (n = 118) or observation (n = 116) following complete resection. The primary
endpoint was overall survival (OS). The secondary endpoint was recurrence free survival
(RFS). Kaplan-Meier methods were used to compare OS and RFS between the two treatment
groups. Cox regression was used to identify factors associated with OS and RFS endpoints.
Both groups had similar baseline characteristics. AC patients had improved 5-year
OS (AC 61.4% vs observation 41.0%, log-rank p = .008) and 5-year RFS (AC 56.2% vs
observation 39.9%, log-rank p = .011) rates compared to observation. Cox regression
analyses confirmed the OS (HR 0.583, 95% CI 0.402-0.846, p = .005) and RFS (HR 0.573,
95% CI 0.395-0.830, p = .003) benefit associated with AC. AC was associated with a
lower risk (HR 0.648, 95% CI 0.435-0.965, p = .0326) and a lower cumulative incidence
(Subdistribution Hazard Ratio [SHR], 0.67, 95% CI 0.449-0.999, p = .0498) of lung
cancer deaths. In the JBR10 trial, treatment with AC conferred a significant OS and
RFS advantage over observation for pN1 NSCLC patients. These data suggest that pN1
NSCLC patients may experience a disproportionately greater clinical benefit from AC
than the 6% survival advantage estimated by the LACE meta-analysis.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 19, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This work was supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. O.T. is partially funded by National Heart Lung and Blood Institute of the National Institutes of Health grant F30HL154324 outside of the submitted work.
Conflicts of Interest: S.C.M. reports support for attending meetings and/or travel from the Keck School of Medicine of the University of Southern California. E.A.D. has received consulting fees from Medtronic.
Ethical Approval: The Institutional Review Board of the University of Southern California Health Science Campus approved this study (HS-19-00942) on December 17, 2019, and waived the requirement for patient consent.
Meeting Presentation: This work was presented as a podium presentation at the 48th Annual Meeting of the Western Thoracic Surgical Association, June 22-25, 2022.
Acknowledgments: The authors would like to acknowledge the Canadian Cancer Trials Group (CCTG) for the provision of data and support with its analysis.
Read at the 48th Annual Meeting of the Western Thoracic Surgical Association, June 22 - 25, 2022, Koloa, Hawaii.
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- Commentary: Old Data Provide New Insights Into the Therapeutic Benefit of Adjuvant Chemotherapy in Non-Small Cell Lung CancerSeminars in Thoracic and Cardiovascular Surgery
- PreviewThe pivotal Lung Adjuvant Cisplatin Evaluation (LACE) meta-analysis demonstrated a clear, albeit modest, survival benefit associated with the administration of adjuvant chemotherapy among patients with resected non-small cell lung cancer (NSCLC).1 Despite publication of these data almost 15 years ago, adjuvant systemic therapy remains grossly underutilized.2 Although the reasons for this discordance are complex and likely multifactorial, it is at least to some degree due to the small magnitude of the identified overall survival benefit.
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