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Pooling five trials settled the question of who benefits from chemotherapy after lung cancer surgery: about five people in a hundred live longer at five years, and none of them has stage IA disease.
LACE pooled individual patient data on 4,584 patients from the five largest trials of cisplatin-based chemotherapy after complete resection conducted after the 1995 non-small-cell lung cancer meta-analysis. At a median 5.2 years, the overall hazard ratio for death was 0.89 (95 percent confidence interval 0.82 to 0.96, p=0.005), a 5.4 percent absolute five-year benefit, with no heterogeneity between trials.
The benefit varied by stage (test for trend p=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) and stage III 0.83 (0.72 to 0.94). Chemotherapy in stage IA disease looked harmful, and it has not been offered since. The drug partner did not significantly change the effect, although vinorelbine gave the numerically best hazard ratio (0.80, 0.70 to 0.91) against etoposide or a vinca alkaloid (0.92) and other partners (0.97). Benefit was larger in patients with better performance status, and did not vary by sex, age, histology, type of surgery, planned radiotherapy or planned cisplatin dose.
LACE is the reference that decides who is offered adjuvant chemotherapy today, and its stage gradient is the reason a 3 cm node-negative tumour is treated differently from a 5 cm one.
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.
4,584 analysed.
5.4 percent absolute five-year benefit
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival, all stagesprimary | Cisplatin-based adjuvant chemotherapy | 4,584 | 5.4 percent absolute five-year benefit | 0.89 (0.82 to 0.96) | 0.005 | link |
| Overall survival, stage IA | Cisplatin-based adjuvant chemotherapy | - | no benefit; point estimate favours observation | 1.4 (0.95 to 2.06) | - | link |
| Overall survival, stage II | Cisplatin-based adjuvant chemotherapy | - | - | 0.83 (0.73 to 0.95) | - | link |
Shares Performance status (ECOG, Karnofsky), Vinorelbine, Etoposide, Resectable stage I to III non-small-cell lung cancer.
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.