Adjuvant chemotherapy for completely resected IIA-IIIA non-small cell lung cancer: compliance to guidelines, safety and efficacy in real-life practice

Anne-Laure Désage; Claire Tissot; Sophie Bayle-Bleuez; Thierry Muron; Nadine Deygas; Valérie Grangeon-Vincent; Brigitte Monange; Fatah Torche; Paul Vercherin; David Kaczmarek; Olivier Tiffet; Fabien Forest; Jean-Michel Vergnon; Wafa Bouleftour; Pierre Fournel

doi:10.21037/tlcr-22-345

Adjuvant chemotherapy for completely resected IIA-IIIA non-small cell lung cancer: compliance to guidelines, safety and efficacy in real-life practice

Transl Lung Cancer Res. 2022 Dec;11(12):2418-2437. doi: 10.21037/tlcr-22-345.

Authors

Anne-Laure Désage¹, Claire Tissot², Sophie Bayle-Bleuez¹, Thierry Muron^{2

3}, Nadine Deygas⁴, Valérie Grangeon-Vincent⁵, Brigitte Monange⁶, Fatah Torche³, Paul Vercherin⁷, David Kaczmarek⁸, Olivier Tiffet⁹, Fabien Forest¹⁰, Jean-Michel Vergnon¹, Wafa Bouleftour³, Pierre Fournel³

Affiliations

¹ Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.
² Oncology Department, Private Loire Hospital (HPL), Saint-Etienne, France.
³ Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.
⁴ Department of Pulmonology, Gier Hospital, Saint-Chamond, France.
⁵ Department of Pulmonology, Roanne Hospital, Roanne, France.
⁶ Department of Medical Oncology, Emile Roux Hospital, Le Puy-en-Velay, France.
⁷ Public Health and Medical Informatics Department, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.
⁸ Thoracic and Digestive Surgery Department, Private Loire Hospital (HPL), Saint-Etienne, France.
⁹ Department of Thoracic Surgery, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.
¹⁰ Pathology Department, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.

Abstract

Background: Since randomised clinical trials demonstrated a survival benefit of adjuvant chemotherapy (AC) following curative-intent lung surgery, AC has been implemented as a standard therapeutic strategy for patients with a completely resected IIA-IIIA non-small cell lung cancer (NSCLC). Regarding the moderate benefit of AC and the lack of literature on AC use in real-life practice, we aimed to evaluate compliance to guidelines, AC safety and efficacy in a less selected population.

Methods: Between January 2009 and December 2014, we retrospectively analysed 210 patients with theoretical indication of AC following curative-intent lung surgery for a completely resected IIA-IIIA NSCLC. The primary objective of this retrospective study was to evaluate compliance to AC guidelines. Secondary objectives included safety and efficacy of AC in real-life practice.

Results: Among 210 patients with a theoretical indication of AC, chemotherapy administration was validated in multidisciplinary team (MDT) for 62.4% of them and 117 patients (55.7%) finally received AC. Patient's clinical conditions were the main reasons advanced in MDT for no respect to AC guidelines. Most of the patients received cisplatin-vinorelbine (86.3%) and AC was initiated within 8 weeks following lung surgery for 73.5% of patients. One-half of patients who received AC experienced side effects leading to either dose-intensity modification or treatment interruption. In real-life practice, AC was found to provide a survival benefit over surgery alone. Factors related to daily-life practice such as delayed AC initiation or incomplete AC planned dose received were not associated with an inferior survival.

Conclusions: Although AC use might differ from guidelines in real-life practice, this retrospective study highlights that AC can be used safely and remains efficient among a less selected population. In the context of immunotherapy and targeted therapies development in peri-operative treatment strategies, the place of AC has to be precised in the future.

Keywords: Adjuvant chemotherapy (AC); non-small cell lung cancer (NSCLC); real-life practice.