title: Long-term results of the international adjuvant lung cancer trial evaluating adjuvant Cisplatin-based chemotherapy in resected lung cancer.
abstract: PURPOSE Based on 5-year or shorter-term follow-up data in recent randomized trials, adjuvant cisplatin-based chemotherapy is now generally recommended after complete surgical resection for patients with non-small-cell lung cancer (NSCLC). We evaluated the results of the International Adjuvant Lung Cancer Trial study with three additional years of follow-up. PATIENTS AND METHODS Patients with completely resected NSCLC were randomly assigned to three or four cycles of cisplatin-based chemotherapy or to observation. Cox models were used to evaluate treatment effect according to follow-up duration. Results The trial included 1,867 patients with a median follow-up of 7.5 years. Results showed a beneficial effect of adjuvant chemotherapy on overall survival (hazard ratio [HR], 0.91; 95% CI, 0.81 to 1.02; P = .10) and on disease-free survival (HR, 0.88; 95% CI, 0.78 to 0.98; P = .02). However, there was a significant difference between the results of overall survival before and after 5 years of follow-up (HR, 0.86; 95% CI, 0.76 to 0.97; P = .01 v HR, 1.45; 95% CI, 1.02 to 2.07; P = .04) with P = .006 for interaction. Similar results were observed for disease-free survival. The analysis of non-lung cancer deaths for the whole period showed an HR of 1.34 (95% CI, 0.99 to 1.81; P = .06). CONCLUSION These results confirm the significant efficacy of adjuvant chemotherapy at 5 years. The difference in results beyond 5 years of follow-up underscores the need for the long-term follow-up of other adjuvant lung cancer trials and for a better identification of patients deriving long-term benefit from adjuvant chemotherapy.
authors.affiliation: Institut Gustave-Roussy, rue Camille Desmoulins, Villejuif 94800, France. Rodrigo.Arriagada@ki.se
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Arriagada
authors.forename: Ariane
authors.initials: A
authors.lastname: Dunant
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pignon
authors.forename: Bengt
authors.initials: B
authors.lastname: Bergman
authors.forename: Mariusz
authors.initials: M
authors.lastname: Chabowski
authors.forename: Dominique
authors.initials: D
authors.lastname: Grunenwald
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Kozlowski
authors.forename: Cécile
authors.initials: C
authors.lastname: Le Péchoux
authors.forename: Robert
authors.initials: R
authors.lastname: Pirker
authors.forename: Maria-Izabel Sathler
authors.initials: MI
authors.lastname: Pinel
authors.forename: Michèle
authors.initials: M
authors.lastname: Tarayre
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Chevalier
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002423:Cause of Death; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged
chemical_list: D002945:Cisplatin