Utilization of adjuvant therapy among completely resected non-small cell lung cancer (NSCLC) patients in the National Comprehensive Cancer Network (NCCN) Outcomes Database Project.

Abstract

7017 Background: In recent years, adjuvant chemotherapy has become the standard of care for completely resected (R0) stage II and IIIA NSCLC patients, while the use of adjuvant therapy in stage IB remains controversial. We evaluated the use of adjuvant therapy among R0 stage IA-IIIA NSCLC patients in the NCCN Outcomes Database Project. Methods: Completely resected stage I-IIIA NSCLC patients who did not receive preoperative therapy were selected for analysis. Eligible patients received adjuvant treatment at 8 participating NCCN institutions between 01/2007 and 06/2009 and were at least 90 days postsurgery. Adjuvant therapy was defined as therapy initiated within 3 months of surgery. Analyses were done on 12/11/09. Results: A total of 498 patients met the inclusion criteria. Patient characteristics were: male 42%; median age 67 yrs; stage IA 39%, IB 35%, II 16%, IIIA 10%; lobectomy (uni or bi) 84% (N=416); adenocarcinoma 58% (N=289); performance status (PS) 0-1 54% (N=271), PS ≥2 3% (N=16), and undocumented PS 42% (N=211). Adjuvant treatment category is presented by stage in the Table. Of patients receiving adjuvant therapy, 5 (4%) did so on a clinical trial. The most common reason for not receiving adjuvant systemic therapy in stage II-IIIA was patient refusal (26%). Conclusions: Adjuvant therapy was commonly administered to stage II and IIIA patients. Radiation was most common among stage IIIA patients. While the majority of R0 NSCLC patients received treatment that follows NCCN guidelines, relatively few patients at these NCCN centers are participating in clinical trials. Adjuvant treatment category by stage Treatment category Stage IA (N=193) IB (N=174) II (N=79) IIIA (N=52) No treatment 190 (98%) 126 (72%) 25 (32%) 14 (27%) Chemotherapy 2 (1%) 43 (25%) 43 (54%) 20 (38%) Cisplatin-based 2 (100%) 25 (58%) 25 (58%) 10 (50%) Carboplatin-based 0 (0%) 14 (33%) 17 (40%) 8 (40%) Other 0 (0%) 4 (9%) 1 (2%) 2 (10%) Chemotherapy + targeted therapy 0 (0%) 2 (1%) 0 (0%) 0 (0%) Targeted therapy alone 0 (0%) 2 (1%) 2 (3%) 1 (2%) Sequential chemo/RT 1 (<1%) 0 (0%) 6 (8%) 13 (25%) Concurrent chemo/RT 0 (0%) 0 (0%) 1 (1%) 3 (6%) RT alone 0 (0%) 1 (<1%) 2 (3%) 1 (2%) Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Abraxis BioScience