Preoperative chemotherapy showed a trend toward improved five-year DFS in NSCLC

13th World Congress on Lung Cancer

Researchers with the Spanish Lung Cancer Group observed a nonsignificant trend toward improved five-year disease-free survival in patients with non–small cell lung cancer who underwent preoperative chemotherapy.

“Preoperative chemotherapy has a nonsignificant trend toward improved DFS when compared with surgery alone. It’s a 4.2% absolute improvement in five-year DFS,” said Enriqueta Felip, MD, with Vall d’Hebron University in Barcelona, Spain. She discussed the results of the NATCH trial during a press conference Monday at the 13th World Conference on Lung Cancer in San Francisco.

The researchers studied 624 chemotherapy-naive patients with early-stage NSCLC treated at 42 European centers from 2000 to 2007. They randomly assigned 212 patients to surgery alone, 211 to adjuvant chemotherapy and 201 to preoperative chemotherapy. Patients in the chemotherapy groups were assigned to three cycles of paclitaxel and carboplatin.

Felip said that exploratory analysis indicated patients with clinical stage II disease showed the most benefit from chemotherapy. She also said compliance was much higher for patients assigned to the preoperative group, 97% vs. 66% in the adjuvant chemotherapy group.

Five-year DFS for patients assigned to surgery alone was 34% compared with 38.3% for preoperative chemotherapy and 36.6% for adjuvant chemotherapy. However, superior DFS did not translate into improved OS.

“In our study, we observed no differences in postoperative mortality between those patients who received surgery upfront and those patients receiving preoperative chemotherapy,” Felip said. “The five-year OS was 44% with surgery, 45.5% with adjuvant chemotherapy and 46.6% with preoperative chemotherapy.”

This is a phenomenally difficult study. It is a model that could not be completed in North America and probably cannot be completed now in Europe, either. This is going to stand alone as the best evidence for or against adjuvant and neoadjuvant chemotherapy in NSCLC. The surprising thing for me is that this shows we can administer more chemotherapy if we do so before surgery, and significantly more people in the preoperative group completed their chemotherapy compared with the adjuvant arm, yet survival is the same. Sadly, survival is also the same in patients who did not have chemotherapy at all. I am not saying chemotherapy does not work; what this shows is that we have to be very selective when choosing patients for chemotherapy.

– Peter Goldstraw, MD

Consultant Thoracic Surgeon, Royal Brompton Hospital, London

For more information:
Felip E. #PRS.3. Presented at: 13th World Conference on Lung Cancer; July 31-Aug. 4, 2009; San Francisco.