# IALT (International Adjuvant Lung Cancer Trial)

Source: https://onco.cc/trials/ialt/  
OnCo record `ialt` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first large trial to show that chemotherapy after lung cancer surgery helps people live longer, though the gain is a few percent rather than a transformation.

## Summary

IALT randomised 1,867 patients with completely resected non-small-cell lung cancer to three or four cycles of cisplatin-based chemotherapy or to observation. Each centre chose the partner drug and its own postoperative radiotherapy policy, so the trial is a test of the strategy rather than of a regimen: etoposide was used in 56.5 percent, vinorelbine in 26.8 percent, vinblastine in 11.0 percent and vindesine in 5.8 percent. Pathological stage was I in 36.5 percent, II in 24.2 percent and III in 39.3 percent.

At a median 56 months, five-year survival was 44.5 percent with chemotherapy against 40.4 percent with observation (469 against 504 deaths, hazard ratio for death 0.86, 95 percent confidence interval 0.76 to 0.98). Three-quarters of the chemotherapy arm received at least 240 mg/m2 of cisplatin.

IALT is the trial that made adjuvant chemotherapy the standard, and its size is the reason the four-to-five percent absolute benefit is believed. Later follow-up weakened the survival difference, which is part of why the LACE pooled analysis was done.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: International Adjuvant Lung Cancer Trial
- Phase: 3
- Setting: Completely resected non-small-cell lung cancer, any stage I to III: three or four cycles of cisplatin-based chemotherapy versus observation, with overall survival as the primary endpoint
- Sponsor: Institut Gustave Roussy and the IALT Collaborative Group
- Enrolled: 1867
- Result: Five-year survival 44.5 against 40.4 percent (hazard ratio for death 0.86).
- Outcomes: Overall survival at 5 years: Cisplatin-based chemotherapy 44.5% vs Observation 40.4%, HR 0.86
- Replication: JBR.10 and ANITA reproduced the benefit with cisplatin and vinorelbine; the LACE pooled analysis of 4,584 patients from the five largest trials confirmed it.

## Sources

- IALT (New England Journal of Medicine 2004): https://doi.org/10.1056/NEJMoa031644

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Platinum agents](https://onco.cc/technologies/platinum/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Vinorelbine](https://onco.cc/drugs/vinorelbine/)
- trials: [ADAURA](https://onco.cc/trials/adaura/), [ANITA (Adjuvant Navelbine International Trialist Association)](https://onco.cc/trials/anita/), [JBR.10 (NCIC CTG)](https://onco.cc/trials/jbr-10/), [LACE (Lung Adjuvant Cisplatin Evaluation) pooled analysis](https://onco.cc/trials/lace-pooled-analysis/)

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