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Previous Volume 355:983-991 September 7, 2006 Number 10 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Reed, E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Adjuvant cisplatin-based chemotherapy improves survival among patients with completely resected non–small-cell lung cancer, but there is no validated clinical or biologic predictor of the benefit of chemotherapy.

Methods We used immunohistochemical analysis to determine the expression of the excision repair cross-complementation group 1 (ERCC1) protein in operative specimens of non–small-cell lung cancer. The patients had been enrolled in the International Adjuvant Lung Cancer Trial, thereby allowing a comparison of the effect of adjuvant cisplatin-based chemotherapy on survival, according to ERCC1 expression. Overall survival was analyzed with a Cox model adjusted for clinical and pathological factors.

Results Among 761 tumors, ERCC1 expression was positive in 335 (44%) and negative in 426 (56%). A benefit from cisplatin-based adjuvant chemotherapy was associated with the absence of ERCC1 (test for interaction, P=0.009). Adjuvant chemotherapy, as compared with observation, significantly prolonged survival among patients with ERCC1-negative tumors (adjusted hazard ratio for death, 0.65; 95% confidence interval [CI], 0.50 to 0.86; P=0.002) but not among patients with ERCC1-positive tumors (adjusted hazard ratio for death, 1.14; 95% CI, 0.84 to 1.55; P=0.40). Among patients who did not receive adjuvant chemotherapy, those with ERCC1-positive tumors survived longer than those with ERCC1-negative tumors (adjusted hazard ratio for death, 0.66; 95% CI, 0.49 to 0.90; P=0.009).

Conclusions Patients with completely resected non–small-cell lung cancer and ERCC1-negative tumors appear to benefit from adjuvant cisplatin-based chemotherapy, whereas patients with ERCC1-positive tumors do not.

Source Information

From the Laboratory of Radiobiology and Oncology, Commissariat à l'Energie Atomique, Fontenay aux Roses, University of Paris 11, Paris (K.A.O., L.S., J.-C.S.); the Biostatistics and Epidemiology Unit (A.D., V.H., J.-P.P.) and the Departments of Pathology and Translational Research (P.F., E.T.) and Medicine (F.A., T.T., T.L.C., J.-C.S.), Institut Gustave Roussy, Villejuif; the Department of Pathology, Centre Hospitalier Universitaire Albert Michallon, Grenoble (E.B.); and the Université Pierre et Marie Curie, Paris (P.F.) — all in France; the Department of Internal Medicine, Medical University of Vienna, Vienna (M.F., R.P.); the Institute of Pathology, University Medical School of Graz, Graz, Austria (H.H.P.); and Klinik und Poliklinik für Onkologie, Universitätsspital, Zurich (R.S.).

Address reprint requests to Dr. Soria at the Department of Medicine, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif, France, or at soria{at}igr.fr.

Full Text of this Article

Related Letters:

DNA Repair by ERCC1 in Non–Small-Cell Lung Cancer
Wilcox J. E., Cecere F., Bria E., Rosell R., Grenader T., Shavit L., Dunant A., Fouret P., Soria J.-C.
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N Engl J Med 2006; 355:2590-2591, Dec 14, 2006. Correspondence

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