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Original Article
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Volume 350:351-360 January 22, 2004 Number 4
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Cisplatin-Based Adjuvant Chemotherapy in Patients with Completely Resected Non–Small-Cell Lung Cancer
The International Adjuvant Lung Cancer Trial Collaborative Group

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ABSTRACT

Background On the basis of a previous meta-analysis, the International Adjuvant Lung Cancer Trial was designed to evaluate the effect of cisplatin-based adjuvant chemotherapy on survival after complete resection of non–small-cell lung cancer.

Methods We randomly assigned patients either to three or four cycles of cisplatin-based chemotherapy or to observation. Before randomization, each center determined the pathological stages to include, its policy for chemotherapy (the dose of cisplatin and the drug to be combined with cisplatin), and its postoperative radiotherapy policy. The main end point was overall survival.

Results A total of 1867 patients underwent randomization; 36.5 percent had pathological stage I disease, 24.2 percent stage II, and 39.3 percent stage III. The drug allocated with cisplatin was etoposide in 56.5 percent of patients, vinorelbine in 26.8 percent, vinblastine in 11.0 percent, and vindesine in 5.8 percent. Of the 932 patients assigned to chemotherapy, 73.8 percent received at least 240 mg of cisplatin per square meter of body-surface area. The median duration of follow-up was 56 months. Patients assigned to chemotherapy had a significantly higher survival rate than those assigned to observation (44.5 percent vs. 40.4 percent at five years [469 deaths vs. 504]; hazard ratio for death, 0.86; 95 percent confidence interval, 0.76 to 0.98; P<0.03). Patients assigned to chemotherapy also had a significantly higher disease-free survival rate than those assigned to observation (39.4 percent vs. 34.3 percent at five years [518 events vs. 577]; hazard ratio, 0.83; 95 percent confidence interval, 0.74 to 0.94; P<0.003). There were no significant interactions with prespecified factors. Seven patients (0.8 percent) died of chemotherapy-induced toxic effects.

Conclusions Cisplatin-based adjuvant chemotherapy improves survival among patients with completely resected non–small-cell lung cancer.


Source Information

The writing committee for the International Adjuvant Lung Cancer Trial (IALT) (Rodrigo Arriagada, M.D., Instituto de Radiomedicina, Santiago, Chile; Bengt Bergman, M.D., Sahlgrenska Hospital, Göteborg, Sweden; Ariane Dunant, M.S., Thierry Le Chevalier, M.D., and Jean-Pierre Pignon, M.D., Ph.D., Institut Gustave-Roussy, Villejuif, France; and Johan Vansteenkiste, M.D., Ph.D., University Hospital Gasthuisberg, Leuven, Belgium) takes responsibility for the content of this article.

Address reprint requests to the IALT Secretariat, Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, 94805 Villejuif, France.

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Related Letters:

Adjuvant Chemotherapy for Lung Cancer
Ikhlaque N., Baumann M. A., Büyükçelik A., Utkan G., Yalçin B., Feliu J., Espinosa E., Sánchez J. J., Sauter C., Morgan G. W., Dunant A., Pignon J.-P., Le Chevalier T.
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N Engl J Med 2004; 350:1681-1683, Apr 15, 2004. Correspondence

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