{"entity":{"id":"paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","kind":"paper","name":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group","aka":[],"tldr":"Pooling 4,584 patients from the five big trials of chemotherapy after lung cancer surgery gave a clear answer: it helps, by about 5 percent at five years, and the benefit is in stage II and III rather than stage IA.","summary":"Pignon, Tribodet, Scagliotti, Douillard, Shepherd and colleagues pooled individual patient data from the five largest trials of cisplatin-based chemotherapy after complete resection conducted after the 1995 meta-analysis: 4,584 patients, median follow-up 5.2 years.\n\nThe stage gradient is the operational result. Chemotherapy after surgery is worth giving in stage II and III disease, is marginal in stage IB and looks actively harmful in stage IA, and no drug partner, patient sex, age, histology or type of surgery changed that. It is the evidence base that adjuvant targeted therapy (ADAURA, ALINA) and adjuvant immunotherapy (IMpower010) were later added to.","asOf":"2026-09-25","links":[{"label":"J Clin Oncol 2008","url":"https://doi.org/10.1200/JCO.2007.13.9030"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/18506026/"}],"tags":["lung-evidence"],"related":["paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995","paper-adaura-nejm-2020","paper-wu-alina-adjuvant-alectinib-nejm-2024","paper-felip-impower010-adjuvant-atezolizumab-lancet-2021"],"cancers":["lung-cancer","nsclc","resectable-nsclc"],"sections":["surgery"],"technologies":["radiotherapy"],"targets":[],"drugs":["cisplatin","vinorelbine","etoposide"],"companies":[],"institutions":[],"pathways":[],"terms":["neoadjuvant-adjuvant","performance-status"],"trials":[],"people":[],"bottlenecks":["b-trial-design","b-dormancy-mrd"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2008,"doi":"10.1200/JCO.2007.13.9030","pmid":"18506026","authors":"Pignon JP, Tribodet H, Scagliotti GV, et al.","paperType":"meta-analysis","findings":["Overall hazard ratio of death 0.89 (95 percent confidence interval 0.82 to 0.96; P equals 0.005), a five-year absolute benefit of 5.4 percent.","Benefit varied with stage (test for trend P equals 0.04): stage IA hazard ratio 1.40 (0.95 to 2.06), stage IB 0.93 (0.78 to 1.10), stage II 0.83 (0.73 to 0.95), stage III 0.83 (0.72 to 0.94).","No significant interaction with the drug given alongside cisplatin: vinorelbine 0.80 (0.70 to 0.91), etoposide or vinca alkaloid 0.92 (0.80 to 1.07), other 0.97 (0.84 to 1.13).","Chemotherapy effect was higher in patients with better performance status.","No interaction with sex, age, histology, type of surgery, planned radiotherapy or planned total cisplatin dose.","No heterogeneity of chemotherapy effect between the five trials."],"whatItMeans":"The rule that a patient with a resected stage II or III lung cancer is offered chemotherapy and a patient with a small stage I tumour is not. Everything added to adjuvant treatment since has had to beat, or be added to, this 5 percent.","caveats":["Trials from the 1990s and early 2000s with the staging of that era; stage migration since means the groups are not exactly today's groups.","Stage IA looked worse with chemotherapy, but the confidence interval crosses one and the number of patients is small.","Pooled trial populations are fitter than the resected population as a whole; performance status modified the effect."],"changedPractice":true,"participants":4584},"route":"/key-papers/paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008/","neighbours":{"paper":[{"id":"paper-adaura-nejm-2020","kind":"paper","name":"ADAURA: three years of osimertinib after surgery for EGFR-mutated lung cancer","route":"/key-papers/paper-adaura-nejm-2020/"},{"id":"paper-felip-impower010-adjuvant-atezolizumab-lancet-2021","kind":"paper","name":"Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010)","route":"/key-papers/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021/"},{"id":"paper-wu-alina-adjuvant-alectinib-nejm-2024","kind":"paper","name":"Alectinib in resected ALK-positive non-small-cell lung cancer","route":"/key-papers/paper-wu-alina-adjuvant-alectinib-nejm-2024/"},{"id":"paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995","kind":"paper","name":"Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials","route":"/key-papers/paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995/"},{"id":"paper-abbosh-phylogenetic-ctdna-lung-cancer-nature-2017","kind":"paper","name":"Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution","route":"/key-papers/paper-abbosh-phylogenetic-ctdna-lung-cancer-nature-2017/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"resectable-nsclc","kind":"cancer","name":"Resectable stage I to III non-small-cell lung cancer","route":"/cancers/resectable-nsclc/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"},{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"vinorelbine","kind":"drug","name":"Vinorelbine","route":"/drugs/vinorelbine/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}]}}