Adjuvant Chemotherapy After Neoadjuvant Therapy and Surgery for Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Oncology

Background:

• Limited data exists on the efficacy of postoperative chemotherapy following neoadjuvant therapy and surgery for locally advanced non-small cell lung cancer (NSCLC).
• Understanding the impact of adjuvant chemotherapy on survival is crucial for treatment optimization in this patient population.

Purpose of the Study:

• To compare survival outcomes, including overall survival (OS) and recurrence-free survival (RFS), between patients with locally advanced NSCLC who received adjuvant chemotherapy versus those who did not, after neoadjuvant therapy and surgery.

Main Methods:

• A retrospective chart review of 156 patients with resectable NSCLC (cT3 N0 or N1-N2) treated between 2009-2016.
• Propensity score matching (PSM) was employed to minimize selection bias when comparing survival between groups.
• Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate OS and RFS.

Main Results:

• Before PSM, adjuvant chemotherapy was associated with significantly shorter RFS (HR 1.79) and a trend towards shorter OS (HR 1.37).
• After PSM, no significant differences in RFS (HR 1.33) or OS (HR 1.25) were observed between patients who received adjuvant chemotherapy and those who did not.
• The median RFS for the entire cohort was 66.3 months, with OS not reached.

Conclusions:

• Adjuvant chemotherapy following neoadjuvant therapy and surgery for locally advanced NSCLC is not associated with improved survival outcomes.
• These findings suggest a need to re-evaluate the role of adjuvant chemotherapy in this specific clinical setting.