Adjuvant carboplatin-based chemotherapy in resected stage IIIA-N2 non-small cell lung cancer

We determined whether adjuvant vinorelbine/paclitaxel plus carboplatin prolonged overall survival among patients with completely resected stage IIIA-N2 non-small cell lung cancer (NSCLC).

We randomly assigned patients with completely resected stage IIIA-N2 NSCLC to a control group or to a treatment group with vinorelbine/carboplatin or paclitaxel/carboplatin doublet adjuvant chemotherapy. The primary endpoint was overall survival; secondary endpoints were disease-free survival and the toxicity and safety of the regimen.

This trial was terminated before accumulation of the planned numbers for registration because of the results of bigger clinical trial. Finally, 150 patients underwent randomization to vinorelbine/paclitaxel plus carboplatin (79 patients) or observation. In the chemotherapy group, 38 patients received vinorelbine plus carboplatin and 41 patients received paclitaxel plus carboplatin. In both groups, the median age was 57 years, 73% were men, and 28% had squamous carcinoma. Chemotherapy caused neutropenia in 82% of the patients (including grade 3 and 4 neutropenia in 42%), and there were no treatment-related deaths in this trial. After a median follow-up of 29 months (range, 1-110 months), the overall survival was significantly prolonged in the chemotherapy group, when compared with the observation group (33 months [95% confidence interval {CI}, 27.4-38.6] versus 24 months [95% CI, 15.8-32.2], p = 0.037), as was disease-free survival (32 months [95% CI, 21.3-42.7] versus 20 months (95% CI, 13.1-26.9), p = 0.020). The 5-year overall survival rates were 31.1% and 19.1%, respectively.

Although with limitations, this clinical trial showed that adjuvant vinorelbine/paclitaxel plus carboplatin has an acceptable level of toxicity and prolongs disease-free and overall survival among patients with completely resected stage IIIA-N2 NSCLC.