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Patients With Non–Small Cell Lung Cancer May Benefit From Delayed Adjuvant Chemotherapy

Key Points

  • The study suggests that the initiation of chemotherapy between 57 and 127 days postoperatively led to similar outcomes as patients who started closer to the currently recommended 6- to 9-week window.
  • Furthermore, delayed chemotherapy was associated with a lower risk of death compared to patients treated with surgery only.
  • “Clinicians should still consider chemotherapy in appropriately selected patients who are healthy enough to tolerate it, up to 4 months after NSCLC surgical resection,” recommended the authors.

A new Yale study suggested that patients with a common form of lung cancer may still benefit from delayed chemotherapy started up to 4 months after surgery, according to the researchers. The study was published by Salazar et al in JAMA Oncology.

Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. For patients with non–small cell lung cancer (NSCLC), adjuvant chemotherapy has been shown to benefit patients with larger tumors or those with cancer in the lymph nodes.

While there is consensus regarding the use of chemotherapy after cancer surgery, the optimal timing is poorly defined. Many clinicians support starting chemotherapy within 6 to 9 weeks of surgery. But factors such as postoperative complications may affect a patient's ability to tolerate chemotherapy following surgery.

Daniel J. Boffa, MD, member of Yale Cancer Center, Clinical Program Leader of the Thoracic Oncology Program at Smilow Cancer Hospital, and Associate Professor of Surgery at Yale School of Medicine, and his coauthors used data from patients in the National Cancer Database to examine the relationship between the timing of postoperative chemotherapy and 5-year mortality.

Study Findings

The study of 12,473 patients with stage I, II, or III disease who received chemotherapy suggests that the initiation of chemotherapy between 57 and 127 days postoperatively led to outcomes similar to those of patients who started closer to the currently recommended 6- to 9-week window, reported the researchers. Furthermore, delayed chemotherapy was associated with a lower risk of death compared to those patients treated only with surgery.

While the study results did not establish causality, they suggest a benefit of delayed chemotherapy for NSCLC patients, said Dr. Boffa.

“Patients treated surgically for NSCLC continue to benefit from chemotherapy when given outside the traditional postoperative window. Clinicians should still consider chemotherapy in appropriately selected patients who are healthy enough to tolerate it, up to 4 months after NSCLC surgical resection,” he said. “Further study is warranted to confirm these findings.” 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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