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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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,867 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 5 yearsprimary | Cisplatin-based chemotherapy | 932 | 44.5% | 0.86 (0.76 to 0.98) | - | link |
| Observation | 935 | 40.4% |
Shares Vinorelbine, ADAURA, Resectable stage I to III non-small-cell lung cancer, Cisplatin.
Shares ANITA (Adjuvant Navelbine International Trialist Association), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Vinorelbine, Resectable stage I to III non-small-cell lung cancer, Cisplatin, Platinum agents.
Shares Etoposide, Resectable stage I to III non-small-cell lung cancer, Cisplatin, Platinum agents.
Shares Resectable stage I to III non-small-cell lung cancer, Cisplatin, Platinum agents, Cytotoxic chemotherapy.
Shares Etoposide, Cisplatin, Platinum agents, Cytotoxic chemotherapy.
Shares Resectable stage I to III non-small-cell lung cancer, Cisplatin, Platinum agents, Cytotoxic chemotherapy.
Shares Resectable stage I to III non-small-cell lung cancer, Cisplatin, Platinum agents, Cytotoxic chemotherapy.