Ten-year overall survival in resectable stage-III NSCLC - Results of the randomized ESPATUE trial - Long-term...

More stage III non-small-cell lung cancer patients experience long-term survival (OS). ESPATUE-trial looked at surgery versus boost-radiochemotherapy following induction chemotherapy, consisting of three cycles of cisplatin 50 mg/m² on days 1 and 8 and paclitaxel 175 mg/m² on day 1 every 21 days, as well as concurrent chemoradiotherapy to 45 Gy given as 1.5 Gy twice daily, concurrent cisplatin 50 mg/m² on days 2 and 9, and concurrent vinorelbine 20 mg/m² on days 2 and 9 (Eberhardt et al, J Clin Oncol 2015). Here, we update 10-years-OS and report competing-risks-of-deaths.

Complete trial design has been published. We updated OS for patients still alive at 2/2022. Patients were followed up on a yearly basis and showed up to get follow-up imaging and reevaluation.

From 1/2004 until 1/2013 246 patients medically and functionally operable were enrolled. Following induction 161 considered resectable were randomized to radiochemotherapy-boost(arm 1/A;n = 80) or definitive surgery(arm 2/B;n = 81).The median time from randomization to last evaluation was 145.1 months(interquartile range 121.5-197.8). Patients in the arm that included surgery(B) had a 10-year overall survival rate of 29.9 %(20.2-40.3) and those with radiochemotherapy(A) a rate of 28.3 %(18.8-38.5; p = 0.70 log rank). Rates of progression-free survival, death from second priomary lung cancer, death from first lung cancer, treatment related death, death from second cancer without lung cancer were comparable in both study arms CONCLUSIONS: Long-term survival serves as baseline information for ongoing immunotherapy-based stage III protocols. No significant differences between local modalities radiochemotherapy and surgery were observed. A competing-risk-of-deaths-analysis showed no relevant preference for one arm. Death from comorbidities and death from second lung cancer remain relevant long-term-risks.