ASCO And CCO Issue New Guideline On Adjuvant Therapy For Non-Small Cell Lung Cancer
Almost 85 percent of all lung cancer cases are of the non-small cell type. Treatment for stages I, II, and IIIA of NSCLC includes surgery to remove the tumor as well as the surrounding lung tissue and lymph nodes, if necessary. By stage IV, the lung cancer has spread throughout the body and is no longer treatable with surgery.
The guideline strongly recommends chemotherapy following successful surgery (when the tumor is completely removed) for patients with stages IIA, IIB, and IIIA lung cancer. The data show that chemotherapy increased the five-year survival rate of patients with stage II by 10 percent or stage IIIA cancers by 13 percent.
"There is now clear evidence that postoperative chemotherapy improves survival in completely resected stage II and IIIA NSCLC," said guideline panel co-chair Katherine M. W. Pisters, MD, with the Department of Thoracic Head & Neck Medical Oncology at the MD Anderson Cancer Center in Houston.
Of people diagnosed with stage IA and IB lung cancer, an estimated 74 percent will be alive 5 years after diagnosis, according to the Surveillance, Epidemiology, and End Results (SEER) Program Statistical Database. Some of the clinical trials which demonstrated a survival benefit for adjuvant chemotherapy included stage I patients. Very few patients with stage IA disease have been studied and adjuvant chemotherapy is not recommended at this time. A trend to improved survival was seen with postoperative chemotherapy in stage IB patients, however, the differences did not achieve statistical significance. Chemotherapy may be an option for some patients with stage IB NSCLC, particularly patients with tumors larger than 4 centimeters, but current data are not strong enough to recommend its routine use.
The benefit of postoperative radiotherapy in stage III NSCLC has been suggested from analyses of the SEER database and retrospective subset findings from phase III trials. The panel did not feel this evidence sufficient to routinely recommend postoperative radiation in stage III NSCLC. Additional data from ongoing phase III studies should clarify this issue soon. Postoperative radiotherapy is detrimental in completely resected stage I and II NSCLC and is not recommended.
In conjunction with this guideline, ASCO developed a Decision Aid Tool, which uses straightforward charts and additional diagrams to explain the risks and benefits of adjuvant therapy to patients and their families. One section, called "Thinking It Over," poses questions about what risks and benefits matter most to the individual patient. It also asks patients to think about how they are making their treatment decisions, including questions about their support system and whether or not they feel pressured to undergo additional treatment.
The goal of the tool is to help doctors better communicate with their patients about their treatment options and prognosis.
"It is really important for doctors and patients to discuss whether or not adjuvant therapy is an appropriate treatment for the patient," said guideline co-author William Evans, MD, one of CCO's regional vice presidents and an oncologist at the Juravinski Cancer Centre in Ontario. "The Decision Aid Tool helps explain patients' options and potential outcomes in a clear way, to help the patient and their loved ones make more informed decisions."
ASCO also released an updated patient guide, Adjuvant Treatment for Lung Cancer. This guide is the patient version of the clinical practice recommendations and is available on ASCO's patient website People Living With Cancer, at http://www.PLWC.org.
"Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer Guideline " by Katherine M. W. Pisters, et al., MD Anderson Cancer Center, Houston, TX and William K. Evans, et al., Juravinski Cancer Centre at Hamilton Health Services, Hamilton, ON, Canada.
This guideline is being published in the November 20 print issue of the Journal of Clinical Oncology (JCO), the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer. It also will be published on CCO's website, at http://www.cancercare.on.ca.
The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. ASCO's nearly 25,000 members from the United States and abroad set the standard for patient care and lead the efforts to discover more effective cancer treatments, increase funding for clinical and translational research, and, ultimately, improve cancer care for the estimated 10 million people diagnosed with cancer worldwide each year. ASCO publishes the Journal of Clinical Oncology (JCO), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces People Living With Cancer, a comprehensive consumer Web site providing oncologist-vetted cancer information to help patients and families make informed health-care decisions.
Cancer Care Ontario is the provincial organization that steers and coordinates Ontario's cancer services and prevention efforts so that fewer people get cancer and patients receive the highest quality of care.
American Society of Clinical Oncology
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