Postoperative Adjuvant Systemic Therapy in Completely Resected Non-Small Cell Lung Cancer: A Systematic Review

• Published in: Clinical lung cancer 2017-05, Vol.18 (3), p.259-273.e8
• Main Authors: Bradbury, Penelope, MD, Sivajohanathan, Duvaraga, MPH, Chan, Adrien, MD, Kulkarni, Swati, MD, Ung, Yee, MD, Ellis, Peter M., MBBS, PhD
• Format: Article
• Language: English
• Subjects: Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Cell Death; Chemotherapy; Chemotherapy, Adjuvant; Clinical trials; Hematology, Oncology and Palliative Medicine; Humans; Immunotherapy; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - surgery; NSCLC; Pneumonectomy; Postoperative Complications - prevention & control; Postoperative Period; Pulmonary/Respiratory; Randomized Controlled Trials as Topic; Survival Analysis; Targeted therapy
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2016.07.002

Abstract Purpose To determine whether the use of postoperative adjuvant systemic therapy in patients with completely resected non-small cell lung cancer (NSCLC) improves survival. Materials and Methods Cancer Care Ontario’s Program in Evidence-Based Care reviewed the evidence to update previously published recommendations for patients with completely resected NSCLC. Relevant studies were identified from a systematic MEDLINE, EMBASE and Cochrane Database of Systematic Reviews search of articles published between 2010 and 2016. All phase III randomized controlled trials (RCTs) and relevant systematic reviews were included. Data on overall survival (OS), disease-free survival, adverse events and quality of life were extracted from each of the studies. Results Two relevant systematic reviews, 13 RCTs and a series of pooled analyses by LACE-Bio were included this review. Adjuvant chemotherapy statistically significantly improves OS for resected stage II-IIIA NSCLC and is recommended. For patients with stage IB NSCLC, there is no significant improvement in OS, however, based on subgroup analyses it is reasonable to consider adjuvant chemotherapy in patients with larger tumours (≥4 cm). Current data do not support the use of adjuvant novel therapies (i.e., EGFR TKIs, bevacizumab, and immunotherapies) either as an addition to or instead of cytotoxic chemotherapy. There are no predictive biomarkers to select patients more likely to benefit from adjuvant chemotherapy. Conclusions Cytotoxic chemotherapy remains the standard of care as adjuvant therapy for patients with resected stage II-IIIA NSCLC. Further clinical trials are needed evaluating targeted agents in molecularly defined subgroups before these agents should be recommended in the adjuvant setting.