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Medical Forum / Diseases and Disorders / Cancer / June 2004Adjuvant chemo for early NSCLC
I just had my 4 month post lobectomy check-up, and as I expected, all was well. If anything had been left behind following the surgery, it would surely have been seen in one of the 10 daily X Rays taken while I was in the hospital! And 4 months is pretty early for recurrence or metastases. However, 2 days after this appointment, I read about two studies presented at the June annual meeting of the American Society of Clinical Oncology showing a 12 to 15 % increase in 5 year survival in patients with resectable *early-stage* (emphasis mine) NSCLC who were given adjuvant chemotherapy using a platinum-based regimen. http://www.medscape.com/viewarticle/480292 Most aggravating to me is the fact that it seems the Canadian study followed patients for at least 8 years after the 16 weeks of treatment, but never reported any of their results before now. At least the oncologist I insisted on speaking with after my surgery was unaware of this study. It seems to me that publishing their findings that there was a 15 % improvement in 5 year survival rate as soon as these results were found could have saved a lot of lives. I was told that if I chose to take adjuvant chemotherapy, based on the results of the study released in January 2004, it should be started within 8 weeks following surgery. I chose not to. I think I would have chosen to go ahead if I had seen these results released in early June 2004. The ultimate decision is the patient's, but it would make deciding easier if you had all the relevant information that is available. Dawn > I just had my 4 month post lobectomy check-up, and as I expected, all was > well. If anything had been left behind following the surgery, it would [quoted text clipped - 25 lines] > > Dawn Dawn, The evidence of benefit is pretty thin. And starting adjuvant therapy 4 months after lobectomy would be just plain daft..... >>I read about two studies presented >> at the June annual meeting of the American Society of Clinical Oncology [quoted text clipped - 12 lines] >The evidence of benefit is pretty thin. >And starting adjuvant therapy 4 months after lobectomy would be just plain daft..... Steph, what about my wife? Her lobectomy was on the 3rd of May and her surgeon wants to see her in an other 8 weeks, that would make it the same time frame as Dawn's. The part that bothers me with the study (obvious statistics) is that they are talking about the "average time to recurrence in the surgery only group was 46.7 months." They also say that the "mean survival in the surgery group was 73 months." That would make it an average of 26 months between the time of recurrence and death of the patient. Having an additional 20 months of average life expectancy for patients having received adjuvant chemotherapy using a platinum-based regimen seems significant to me. > >>I read about two studies presented > >> at the June annual meeting of the American Society of Clinical Oncology [quoted text clipped - 28 lines] > having received adjuvant chemotherapy using a platinum-based regimen > seems significant to me. The benefit, if there is any, for adjuvant chemo for early stage NSCLC is small. But we really don't know if there is any. One swallow does not a summer make..... Personally, I would not go that route on the basis of the available evidence >> >> a 12 to 15 % increase in 5 year survival in patients with resectable >> >> NSCLC who were given adjuvant chemotherapy using a platinum-based regimen. [quoted text clipped - 16 lines] >make..... >Personally, I would not go that route on the basis of the available evidence Thanks. According to data available to you, what is the average life expectancy for stage I and II patients at time of diagnosis of recurrence. This is an important consideration for me now. Money is a little tight and we are talking to a financial advisor about structuring the RRSP payout, which he suggests to be over a 30 year period. With data given in the cited report, it appears to me that an average of 10 years after surgery is all that can be expected. If that is the case I would have the payout period drastically reduced so that there will be more disposable money to enjoy traveling and going out. Orping > >> >> a 12 to 15 % increase in 5 year survival in patients with resectable > >> >> NSCLC who were given adjuvant chemotherapy using a platinum-based regimen. [quoted text clipped - 33 lines] > > Orping The median 5 year survival rates in the literature are all over the place, but average about 20% for stage I and 10% for stage II Some series have very highly selected patients, and as expected, do better. > what about my wife? > Her lobectomy was on the 3rd of May and her surgeon wants to see her [quoted text clipped - 10 lines] > having received adjuvant chemotherapy using a platinum-based regimen > seems significant to me. I'd sure like to see the entire report. Some statements are confusing. Although only Stage 1 and l l were included, they say most of the 243 treated patients did not have a recurrence during the study (5 years?, 8 years?), but the average time to recurrence in the surgery only group was 46.7 months. That makes it sound like everyone who did not get chemo had a recurrence, which is unlikely. Then they switch to mean time for survival - 73 months for surgery only, 94 months for treated patients. Since mean age at the start was 61, some are going to die from other causes. Steff's reply to you seems to imply that he thinks these studies are either flawed or flukes. But the oncologist I spoke with was willing to let me go ahead with chemotherapy based on a study reporting only a 4.1 % increased survival. After considering the usual side effects, the relatively low rate of benefit, and the fact that this study included all surgically resectable lung cancers regardless of stage and there was no breakdown of benefit by stage, I chose not to take the chemo. But if I'd had my surgery only 6 weeks ago, I'd sure want to discuss this latest article with an oncologist as soon as possible. Dawn >Steff's reply to you seems to imply that he thinks these studies are either >flawed or flukes. But the oncologist I spoke with was willing to let me go [quoted text clipped - 5 lines] >weeks ago, I'd sure want to discuss this latest article with an oncologist >as soon as possible. Dawn, I'll try to talk to the surgeon tomorrow, if he is in. I cannot bring this up with my wife as she thinks the lobectomy has taken care of everything for ever (even though she has been told about percentages and I tried to use the analogy of mushrooms, explaining that spores may still be around and may grow some day even though all visible mushrooms have been picked). Orping. > Dawn, > The evidence of benefit is pretty thin. 5 year survival of 69 % with chemo, 54 % without, seems thick enough to me. Are you refering to the fact that there were only 240 (+/-) patients in each group in the Canadian study and 170 (+/-) in each group in the American one? > And starting adjuvant therapy 4 months after lobectomy would be just plain > daft..... I was afraid you'd say that. :~) So at least I don't have to bother trying to come to a sensible decision again. Dawn 1. The studies are still mixed. Some recent Euorpean studies showed limited utility to adjuvant chemo. 2. Cisplatin particularly is a tough drug. 3. Gene therapy with stuff life celebrex and Iressa may make more sense since they impact fewer cells, are more directed, and have fewer side effects. >Subject: Re: Adjuvant chemo for early NSCLC >From: "Black Sheep" dawnedondawn@hotmail.com [quoted text clipped - 15 lines] > >Dawn > 1. The studies are still mixed. Some recent Euorpean studies showed limited > utility to adjuvant chemo. [quoted text clipped - 22 lines] > > > >Dawn Sounds like there is a marginal benefit but the price in chemo side effects and consequent loss of quality of life including loss of time spent having the treatment would have to to be a definite negative offset. MIKE |
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