Delayed Chemotherapy May Help Post-Surgical Cancer Patients

A new study suggests that patients with non-small-cell lung cancer (NSCLC) may still benefit from delayed adjuvant chemotherapy started up to four months after surgery.

Researchers at Yale School of Medicine conducted a retrospective observational study involving 12,473 patients with completely resected NSCLC who received post-operative chemotherapy. The study population was limited to patients with lymph node metastases, tumors over four centimeters in diameter, or local extension, and who received chemotherapy between 18 and 127 days after resection. The main outcome was difference in survival according to the time interval between resection and the initiation of postoperative chemotherapy.

The results identified that the lowest mortality risk occurred when adjuvant chemotherapy was started 50 days postoperatively, and not during the currently recommended 6-9 week window. In addition, chemotherapy initiation after this interval (and up to the study limit of 127 days) did not increase mortality. In addition, patients who received chemotherapy during the later interval also had a lower mortality risk than those treated with surgery alone. The study was published on January 5, 2017, in JAMA Oncology.

“Patients treated surgically for NSCLC continue to benefit from chemotherapy when given outside the traditional postoperative window,” concluded lead author associate professor of surgery Daniel Boffa, MD, and colleagues. “Clinicians should still consider chemotherapy in appropriately selected patients who are healthy enough to tolerate it, up to four months after NSCLC surgical resection. Further study is warranted to confirm these findings.”

There are two main types of lung cancer, with the majority (80-85%) being NSCLC and about 10-15% being small cell lung cancer (SCLC), with the main difference between them being treatment approach and prognosis. NSCLC is composed of adenocarcinoma (40%), which is usually found in outer parts of the lung; squamous cell carcinoma (25-30%), which is often linked to a history of smoking and tends to be found near a main bronchus; and large cell (undifferentiated) carcinoma (10-15%), which can appear in any part of the lung and tends to grow and spread quickly.