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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Highlights from the Tenth World Conference on lung cancer,Tracey L,Evans,The oncologist 2004;9:232-238,The conference was held in Vancouver,Canada,ppt made by leeyong,Adjuvant Chemotherapy in non-small-cell lung cancer,International adjuvant lung cancer trial(,IALT,),from 1995-2000,1867 pts from 148 centers in 33 countries,pts undergone complete resection of NSCLC,chemotherapy arm,vs,observation arm,Chemotherapy used in IALT,Adjuvant chemotherapy regimen%of the pts,Cisplatin 300-400mg/m,2,over 3-4 cycles with,etoposide,vinovelbine,vinblastin,vindesine,56,27,11,6,International adjuvant lung cancer trial(,IALT,),Thoracic radiotherapy was optional,Chemotherapy was administered with 60 days,35%pts in each arm underwent,pneuonectomy,and the remainder had,lobectomy,39%of pts in each arm had stage,and 46%had,scc,International adjuvant lung cancer trial(,IALT,),74%pts received at least 240mg/m,2,of DDP;8%pts,assigned to the chemotherapy arm received no chemotherapy,The lethal treatment-associated toxicity rate in the chemotherapy arm was 0.8%,Outcome data from IALT,Chemotherapy arm,Control,P value,Median survival,50.8 months,44.4 months,0.03,5-year survival rate,44.5%,40.4%,Median disease-free survival,40.2 months,30.5 months,0.003,5-year disease-free survival rate,39.4%,34.3%,Lethal toxicity rate,0.8%,0,Absolute 5-year survival benefit of 4.1%,Absolute 5-year disease-free survival benefit of 5.1%,and hazard ratio was o.83%,The Big Lung Trial(BLT),Large,multicenter,study in the UK,All pts with NSCLC received primary therapy,as determined by stage(surgery,radiation,or BSC),Pts randomized to receive either three 3-weekly cycles of DDP-based chemotherapy,DDP/VDS,MMC/IFO/DDP,MMC/VLB/DDP,NVB/DDP,or no chemotherapy,The Big Lung Trial(BLT),In the subgroup of pts receiving BSC as their primary modality,there was a statistically significant survival benefit for chemotherapy,There was no benefit to chemotherapy in terms of overall survival or progression-free survival,The overall survival hazard ratio for chemotherapy was 1.02(95%CI=0.77-1.35),Adjuvant lung project ITALY(ALPI),1209 pts with completely,resected,NSCLC were randomly assigned to received either,MMC,VDS,and DDP every 3 weeks for 3 cycles or no chemotherapy,69%of the pts assigned to the chemotherapy,arm received all 3 cycles.,Stage disease was present in 28%-29%of pts,while the remainder were stage or stage,Adjuvant lung project ITALY(ALPI),43%of the pts in each group were schedule,to have postoperative radiation therapy,and fewer in the chemotherapy group were able to complete it(65%,vs,82%),There was no significant difference in,overall,survival,(OR=o.96,95%CI=0.81-1.13,p=0.589)between the two groups or,progression-free survival,(OR=0.89,95%CI=0.76-1.03,p=0.128),commentary,Only 50%of the early-stage pts of NSCLC underwent surgical resection are alive 5 years later,A meta-analysis of postoperative radiotherapy actually showed a survival decrement,Individual randomized trials of adjuvant chemotherapy have been suboptimal due to the use of older,less effective chemotherapy regimens,poor chemotherapy compliance,and insufficient power to detect small benefits,commentary,NSCLCCG performed a meta-analysis examining the benefit of adjuvant chemotherapy,17 trials were identified that compared surgery and chemotherapy with surgery alone,There was a,nonsignificant,trend toward worse survival in the pts who received chemotherapy due primarily to the studies including,alkylating,agents,which consistently led to worse survival than with surgery alone(OR=1.15,p=o.oo5),commentary,Analysis limited to the,8 trials using DDP-based chemotherapy showed a trend toward better survival in the chemotherapy group that was nearly significant(OR=o.87,p=0.08),Absolute survival benefit of 5%at 5 years,commentary,At 1867 pts,the,IALT,study remains the largest adjuvant trial presented to date,The IALT study was large enough to determine that the very small benefits were statistically significant,Why was the IALT study positive while the BLT and ALPI were not?,commentary,Size and hazard ratio of overall survival in recent large adjuvant studies,Hazard ratio for chemotherapy,95%CI,n,NSCLCCG,1,394,o.87,ALPI,1,209,0.96,IALT,1,869,0.86,BLT,381,1.02,commentary,Some point to the better compliance with treatment in the IALT study,74%of the pts chemotherapy pts in the IALT study received at least 240mg/m,2,of DDP,In the BLT and ALPI,64%and 69%of pts,respectively,received all 3 chemotherapy cycles.,There may be a real benefit for adjuvant chemotherapy in NSCLC,but the magnitude of this benefit is likely quite small,commentary,Per IALT data,25 pts must be treated to convert one person who otherwise would have died from the disease into a 5-year survivor,One of every 125 pts treated experience lethal toxicity with the IALT regimens,and those pts die within 6 months of surgery,whereas pts who die of relapse usually live 1-2 year beyond surgical resection.,comment
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