title: Randomized phase III intergroup trial of isotretinoin to prevent second primary tumors in stage I non-small-cell lung cancer.
abstract: BACKGROUND
  Promising data have suggested that retinoid chemoprevention may help to control second primary tumors (SPTs), recurrence, and mortality of stage I non-small-cell lung cancer (NSCLC) patients.
  
  
  METHODS
  We carried out a National Cancer Institute (NCI) Intergroup phase III trial (NCI #I91-0001) with 1166 patients with pathologic stage I NSCLC (6 weeks to 3 years from definitive resection and no prior radiotherapy or chemotherapy). Patients were randomly assigned to receive a placebo or the retinoid isotretinoin (30 mg/day) for 3 years in a double-blind fashion. Patients were stratified at randomization by tumor stage, histology, and smoking status. The primary endpoint (time to SPT) and the secondary endpoints (times to recurrence and death) were analyzed by log-rank test and the Cox proportional hazards model. All statistical tests were two-sided.
  
  
  RESULTS
  After a median follow-up of 3.5 years, there were no statistically significant differences between the placebo and isotretinoin arms with respect to the time to SPTs, recurrences, or mortality. The unadjusted hazard ratio (HR) of isotretinoin versus placebo was 1.08 (95% confidence interval [CI] = 0.78 to 1.49) for SPTs, 0.99 (95% CI = 0.76 to 1.29) for recurrence, and 1.07 (95% CI = 0.84 to 1.35) for mortality. Multivariate analyses showed that the rate of SPTs was not affected by any stratification factor. Rate of recurrence was affected by tumor stage (HR for T(2) versus T(1) = 1.77 [95% CI = 1.35 to 2.31]) and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking status = 3.11 [95% CI = 1.00 to 9.71]). Mortality was affected by tumor stage (HR for T(2) versus T(1) = 1.39 [95% CI = 1.10 to 1.77]), histology (HR for squamous versus nonsquamous = 1.31 [95% CI = 1.03 to 1.68]), and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking = 4.39 [95% CI = 1.11 to 17.29]). Mucocutaneous toxicity (P<.001) and noncompliance (40% versus 25% at 3 years) were higher in the isotretinoin arm than in the placebo arm.
  
  
  CONCLUSIONS
  Isotretinoin treatment did not improve the overall rates of SPTs, recurrences, or mortality in stage I NSCLC. Secondary multivariate and subset analyses suggested that isotretinoin was harmful in current smokers and beneficial in never smokers.
authors: Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 236, Houston, TX 77030-4095, USA. slippman@mdanderson.org
authors: S M
authors: SM
authors: Lippman
authors: J J
authors: JJ
authors: Lee
authors: D D
authors: DD
authors: Karp
authors: E E
authors: EE
authors: Vokes
authors: S E
authors: SE
authors: Benner
authors: G E
authors: GE
authors: Goodman
authors: F R
authors: FR
authors: Khuri
authors: R
authors: R
authors: Marks
authors: R J
authors: RJ
authors: Winn
authors: W
authors: W
authors: Fry
authors: S L
authors: SL
authors: Graziano
authors: D R
authors: DR
authors: Gandara
authors: G
authors: G
authors: Okawara
authors: C L
authors: CL
authors: Woodhouse
authors: B
authors: B
authors: Williams
authors: C
authors: C
authors: Perez
authors: H W
authors: HW
authors: Kim
authors: R
authors: R
authors: Lotan
authors: J A
authors: JA
authors: Roth
authors: W K
authors: WK
authors: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000517:prevention & control*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000517:prevention & control*; D010919:Placebos; D012907:Smoking / Q000009:adverse effects
chemical_list: D016588:Anticarcinogenic Agents; D010919:Placebos; D015474:Isotretinoin