Brief course of chemotherapy after surgery should be the new standard of care around the world

Jun 27 2005

A Canadian national clinical trial has found that chemotherapy following surgery for early-stage non-small cell lung cancer significantly improves survival for the disease over just surgery alone.

The research, funded by the Canadian Cancer Society and appears in the New England Journal of Medicine.

"With the very significant benefits documented in this study, we are recommending that a brief course of chemotherapy after surgery should be the new standard of care around the world," says Canadian Cancer Society researcher Dr. Timothy Winton, chair of the study and associate professor and director of the Division of Thoracic Surgery at the University of Alberta Hospital in Edmonton.

"In fact, when post-operative chemotherapy was adopted as a standard of care in breast and colon cancer, it was based on data demonstrating much less benefit to what we have now achieved for lung cancer patients," he added.

In the seven-year study involving 482 patients from Canada and the United States, investigators led by Dr. Winton found that post-surgical treatment with the chemotherapy drugs vinorelbine and cisplatin increased the survival rate after five years by 15 per cent. Prior to this research, surgery was the only treatment available for patients with this common type of lung cancer, but the tumour often recurred outside of the lung within a few years and was then incurable.

"Cancer care specialists throughout Canada, the United States, United Kingdom, Scandinavia, Europe, South East Asia and Australia are now giving chemotherapy treatment after surgery to their patients with early-stage non-small cell lung cancer," says Dr. Frances Shepherd, chair of the lung site group committee of the National Cancer Institute of Canada Clinical Trials Group, the organization that coordinated the study. Dr. Shepherd is also a medical oncologist at Princess Margaret Hospital in Toronto and professor of medicine at the University of Toronto.

Lung cancer is one of the most common forms of cancer worldwide, and is the leading cause of death from cancer in North America. Non-small cell lung cancer is the most common type of lung cancer, accounting for more than 80 per cent of all cases. An estimated 22,200 Canadians will be diagnosed with lung cancer this year.

In the study, 242 patients with stage Ib or II non-small cell lung cancer whose tumours had been completely removed received a 16-week course of vinorelbine and cisplatin shortly after surgery. Their outcomes were compared to 240 patients who received surgery alone. In addition to a 15 per cent improvement in the five-year survival rate (69 per cent with chemotherapy versus 54 per cent in the surgery alone group), the rate of cancer recurrence after five years was also significantly reduced--49 per cent in chemotherapy patients versus 61 per cent with patients who received surgery alone.

Among those who did have their cancer relapse, the time between surgery and recurrence was also significantly longer among chemotherapy patients compared to the surgery alone patients.

"These major benefits were achieved with an inexpensive, short period of treatment with limited, short-lived toxic side effects and no major long-term impacts on quality of life," adds Dr. Winton.

Dr. Barbara Whylie, CEO of the Canadian Cancer Society, says "Canadian researchers are breaking through the barriers of what can be achieved in the treatment of lung cancer. Their leadership in this important area will have a significant impact on the lives of people with lung cancer in Canada and around the world. We're delighted to have been a key player in supporting this work."

The lung cancer clinical trial was coordinated by the National Cancer Institute of Canada Clinical Trials Group, which is funded by the Canadian Cancer Society. The Clinical Trials Group is based at Queen's University in Kingston, Ont. With Society funding, the Clinical Trials Group has participated in many groundbreaking trials that have helped change treatment or improve the quality of life for cancer patients worldwide. This research was also supported by the National Cancer Institute in the United States, GlaxoSmithKline and the Canadian Institutes of Health Research.