Abstract 1218P
Background
Adjuvant chemotherapy in resected non-small cell lung cancers (NSCLC) intends to reduce the risk of recurrence. ESMO guidelines recommend adjuvant chemotherapy for N1 and N2 disease and tumours greater than 4 cm in diameter. However, recurrence-risk reduction is limited with 5% benefit at 5 years. If treatment is well tolerated, this is an acceptable improvement, but with increased toxicity, the risk:benefit ratio requires careful consideration.
Methods
We carried out a retrospective analysis of adjuvant lung cancer chemotherapy in a large academic cancer hospital over seven years, from February 2011 to October 2018. Clinicopathological data was reviewed. Oncological regimen was collected and need for dose reductions, discontinuations and treatment related adverse events and hospitalisations, recurrence free and overall survival of patients gathered.
Results
Of the 659 patients who underwent thoracic oncology surgery, 66 patients (10%) received adjuvant chemotherapy. Approximately half were male (51%) and 80% were smokers. Median age of patients at diagnosis was 68 years (53 – 79 years) with median tumour size 4 cm (0.6 – 10.2 cm) and 76% (n=50) were node positive. The most common histologic subtype was adenocarcinoma 64% (n=42) followed by squamous cell carcinoma 24%. The majority of patients completed adjuvant chemotherapy without dose reduction or modification 67% (n=44, 67%). Dose reduction was required in 18% and chemotherapy was discontinued in 16% (n=10) early due to treatment related toxicities. There were no chemotherapy related fatalities. Overall 20% (n=13) patients required hospital admission. Of those who developed disease recurrence (48%), median time to relapse was 13 months (4 – 89 months). The majority of relapsed cancers 72% (n=23) had completed adjuvant chemotherapy without dose reduction or delays.
Conclusions
Although adjuvant chemotherapy is recommended for resected NSCLC with positive nodal spread and greater than 4 cm in diameter, the benefit is small. Furthermore, with one in five patients required hospitalisation during adjuvant chemotherapy and there was significant treatment related toxicity in 18%. Cautious conversations are needed with candidates for adjuvant chemotherapy regarding the risk:benefit ratio.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
S. Iqbal: Travel/Accommodation/Expenses: Janssen; Travel/Accommodation/Expenses: Ipsen. P. O. Dea: Travel/Accommodation/Expenses: Roche. R. Bambury: Advisory/Consultancy, Travel/Accommodation/Expenses: Bayer; Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen; Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Travel/Accommodation/Expenses: Ipsen. D. Collins: Honoraria (self), Honoraria (institution): Pfizer; Honoraria (institution): AstraZeneca; Advisory/Consultancy, Travel/Accommodation/Expenses: MSD; Travel/Accommodation/Expenses: Roche; Honoraria (self), Travel/Accommodation/Expenses: Genmab. All other authors have declared no conflicts of interest.