Abstract
To the Editor: Olaussen and colleagues (Sept. 7 issue)1 report a survival benefit associated with the absence of the excision repair cross-complementation group 1 (ERCC1) protein in patients with completely resected non–small-cell lung cancer who received adjuvant cisplatin-based chemotherapy. Most of the operative specimens of ERCC1positive tumors examined were squamous-cell carcinoma, whereas the ERCC1-negative tumors were almost evenly divided between squamouscell carcinoma and adenocarcinoma.1 Does this skewed distribution reflect a selection bias? Originally, the International Adjuvant Lung Cancer Trial (IALT) showed a difference in survival of 2.3 percentage points for patients with squamous-cell tumors who received cisplatin (as compared with those in the control group who did not receive cisplatin-based chemotherapy). Among patients with adenocarcinoma who received cisplatin, the survival difference was 4.9 percentage points. The absolute 5-year survival benefit was 4.1 percentage points.2 Does this difference fail to differentiate between the two histologic types? Lower expression of ERCC1 is correlated with adenocarcinoma,1 decreased survival,3 and the most benefit from adjuvant cisplatin-based therapy.1 ERCC1 expression in squamous-cell carcinoma may be more useful than the histologic type as a guide to chemotherapy.
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