Improved compliance with adjuvant vinorelbine and cisplatin in non-small cell lung cancer
Hematology/Oncology and Stem Cell Therapy
265 C omplete surgical resection is the best hope for cure in patients with operable non-small cell lung cancer (NSCLC), yet the 5-year overall survival rate is only 23% to 67%, depending on stage, which is based on the size of the primary tumor, the presence or absence of invasion and lymph node in-volvement. 1 Forty to 60 percent of Stage IB and II pa-tients will eventually experience relapse with two-thirds occurring systemically. 2 On the basis that micrometas-tases are responsible for
... esponsible for disease recurrence in the ma-jority of patients, the role of adjuvant chemotherapy has been examined extensively over the last few decades. However, the benefit of adjuvant treatment in terms of overall survival has only recently been confirmed in clinical trials.       from the a King faisal specialist hospital and research centre, riyadh, saudi arabia, b princess margaret hospital, toronto canada, c university of toronto, toronto canada, and the d mount sinai hospital, toronto, canada correspondence: ali aljubran, md · department of oncology, mbc 64, King faisal specialist hospital and research centre, po box 3354, riyadh 11211hematol oncol stem cel ther 2009; 2(1): 265-271 BACKGROUND AND OBJECTIVES: poor compliance has been a common feature in clinical trials of adjuvant chemotherapy for nsclc with only 48% to 69% of patients completing all planned cycles. We retrospectively evaluated compliance and toxicity of platinum-based chemotherapy in the 2 years following recent reports of successful adjuvant chemotherapy trials for nsclc. PATIENTS AND METHODS: patients who received adjuvant chemotherapy after complete resection of nsclc between may 2003 and may 2005 were analyzed retrospectively. patient demographics, ecoG status, stage, pathologic subtype and type of surgery were recorded. the number of chemotherapy cycles, delays, dose reduc-tions and change of chemotherapy were reported. RESULTS: fifty patients were identified. the median age was 62 years (38% stage i, 18% stage ii, 30% stage iii and 14% had multiple primary tumors of variable stages). twenty percent were ecoG ps2; only 12% had undergone pnemonectomy. forty-one patients (82%) started cisplatin/vinorelbine (three switched to carboplatin because of nephrotoxicity, and one switched to carboplatin/paclitaxel because of fatigue and vomiting). three patients received other cisplatin-based combinations; six received carboplatin-based treatment (one each be-cause of advanced age and cardiac dysfunction and 4 because of preexisting neuropathy). eighty percent com-pleted all treatment; 40% required a dose reduction and 58% required delays in treatment. six events of febrile neutropenia were reported in 5 patients and 5 patients required admission for toxicity. there were no toxic deaths. multivariate analysis showed no effect of age, gender, extent of surgery or ecoG status on compliance, need for treatment modification or toxicity. CONCLUSIONS: compared to historical trials, adjuvant platinum-based chemotherapy for resected nsclc is now accepted by patients and physicians with a high degree of compliance.