第十届世界肺癌会议(英文)

NSCLCCG ALPI IALT BLT
n Hazard ratio for chemotherapy 95% CI
1,394 1,209 1,869 381
o.87 0.96 0.86 1.02
0.74-1.02 0.81-1.13 0.76-0.98 0.77-1.35
commentary
Some point to the better compliance with treatment in the IALT study
Chemotherapy used in IALT
Adjuvant chemotherapy regimen
% of the pts
Cisplatin 300-400mg/m2 over 3-4 cycles with
etoposide
56
vinovelbine
27
vinblastin
11
vindesine
There may be a real benefit for adjuvant chemotherapy in NSCLC, but the magnitude of this benefit is likely quite small
commentary
Per IALT data, 25 pts must be treated to convert one person who otherwise would have died from the disease into a 5-year survivor
5-year survival rate
44.5%
Median disease-free survival 40.2 months
5-year disease-free survival rate 39.4%
44.4 months <0.03 40.4% 30.5 months <0.003 34.3%
Individual randomized trials of adjuvant chemotherapy have been suboptimal due to the use of older, less effective chemotherapy regimens, poor chemotherapy compliance, and insufficient power to detect small benefits
There was no significant difference in overall survival (OR=o.96, 95% CI=0.81-1.13, p=0.589) between the two groups or progression-free survival (OR=0.89, 95% CI=0.76-1.03, p=0.128)
Absolute survival benefit of 5% at 5 years
commentary
At 1867 pts, the IALT study remains the largest adjuvant trial presented to date
The IALT study was large enough to determine that the very small bennificant
6
International adjuvant lung cancer trial (IALT)
Thoracic radiotherapy was optional Chemotherapy was administered with 60 days 35% pts in each arm underwent
The Big Lung Trial (BLT)
In the subgroup of pts receiving BSC as their primary modality, there was a statistically significant survival benefit for chemotherapy
Why was the IALT study positive while the BLT and ALPI were not?
commentary
Size and hazard ratio of overall survival in recent large adjuvant studies
The lethal treatment-associated toxicity rate in the chemotherapy arm was 0.8%
Outcome data from IALT
Chemotherapy arm Control
P value
Median survival
50.8 months
One of every 125 pts treated experience lethal toxicity with the IALT regimens, and those pts die within 6 months of surgery, whereas pts who die of relapse usually live 1-2 year beyond surgical resection.
Adjuvant lung project ITALY(ALPI)
43% of the pts in each group were schedule to have postoperative radiation therapy, and fewer in the chemotherapy group were able to complete it (65% vs 82%)
commentary
Only 50% of the early-stage pts of NSCLC underwent surgical resection are alive 5 years later
A meta-analysis of postoperative radiotherapy actually showed a survival decrement
Adjuvant lung project ITALY(ALPI)
1209 pts with completely resected NSCLC were randomly assigned to received either MMC, VDS, and DDP every 3 weeks for 3 cycles or no chemotherapy
There was a nonsignificant trend toward worse survival in the pts who received chemotherapy due primarily to the studies including alkylating agents, which consistently led to worse survival than with surgery alone (OR=1.15,p=o.oo5)
Lethal toxicity rate
0.8%
0
The overall survival hazard ratio for chemotherapy was 0.86 95% CI=0.76-0.98 Absolute 5-year survival benefit of 4.1% Absolute 5-year disease-free survival benefit of 5.1%, and hazard ratio was o.83%
commentary
NSCLCCG performed a meta-analysis examining the benefit of adjuvant chemotherapy
17 trials were identified that compared surgery and chemotherapy with surgery alone
There was no benefit to chemotherapy in terms of overall survival or progression-free survival
The overall survival hazard ratio for chemotherapy was 1.02 (95%CI=0.77-1.35)
Highlights from the Tenth World Conference on lung
cancer
Tracey L, Evans The oncologist 2004;9:232-238 The conference was held in Vancouver, Canada
ppt made by leeyong
Adjuvant Chemotherapy in nonsmall-cell lung cancer
International adjuvant lung cancer trial (IALT) from 1995-2000 1867 pts from 148 centers in 33 countries pts undergone complete resection of NSCLC chemotherapy arm vs observation arm
69% of the pts assigned to the chemotherapy arm received all 3 cycles.
Stage Ⅲ disease was present in 28%-29% of pts, while the remainder were stage Ⅰor stage Ⅱ