Drug delivery and toxicity of adjuvant chemotherapy for non-small cell lung cancer (NSCLC): Washington University experience

Abstract

To the EditorSeveral randomized trials utilizing platinum baseddoublet regimens have shown a survival benefit foradjuvant chemotherapy for non-small cell lungcancer (NSCLC) [1 5]. Adjuvant chemotherapy isincreasingly used in the USA following the publica-tions of the above mentioned studies. To our knowl-edge, there have been no reports on delivery andtoxicity of adjuvant chemotherapy for NSCLC out-side the clinical trial setting. We performed an auditof all patients with NSCLC who underwent surgicalresection and received adjuvant chemotherapy atWashington University School of Medicine betweenJanuary 2003 and December 2005. A total of 40patients were identified to have received adjuvantchemotherapy for NSCLC. The median age in thisgroup was 57 years (range 40 73). The majority ofpatients (68%) were Caucasian with African Amer-icans representing 27% of the population. Men andwomen were represented in equal proportions. Over90% of the patients had a favorable (0 1) Adultcomorbidity evaluation score-27 (ACE-27) at thetime of surgery. The median time from surgery tothe start of cycle 1 of chemotherapy was 49 (range16 118) days. Cisplatin with docetaxel was the mostfrequently used (43%) adjuvant chemotherapy regi-men during the study period followed by carboplatinand paclitaxel (17%), carboplatin and docetaxel(17%), and carboplatin and gemcitabine (15%).Of the 40 patients, 16 (40%) had received theintended dose (all the scheduled cycles without anydose modifications or delays). Seven patients (18%)did not receive the planned cycles of chemotherapywhile 21 (53%) patients had dose reductions and3 (8%) had dose delays (Table I). Adjuvant therapywas discontinued without completion of the sched-uled number of cycles due to toxicities in 6 (15%).Seventeen patients (42%) reported grade 3/4 toxi-cities, most commonly neutropenia and fatigue.Neutropenic fever occurred in two patients. Therewere no deaths resulting from adjuvant chemo-therapy.Most of the current data regarding delivery andtolerability of adjuvant chemotherapy for NSCLCare obtained from prospective studies [4,6 9] cis-platin and docetaxel, 11 (65%) received full doses ofchemotherapy without dose reduction, delays oromission. Grade 3/4 neutropenia in our studyoccurred in 25% of the patients as opposed to 36%in the CALGB 9633 trial, 17.5% (grade 4 alone) inthe IALT trial and 85% in the ANITA trial [2,4,7].This report provides the first ‘‘real life’’ experienceregarding the chemotherapy delivery and toxicity inpatients with resected non-small cell lung canceroutside the context of clinical trials.