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Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among US Patients With Early-Stage NSCLC
A recent study found that among participants in a screening protocol for adjuvant clinical trials for resected early-stage non–small cell lung cancer (NSCLC), only 53% underwent adequate lymph node dissection and 57% received adjuvant chemotherapy, despite guideline indications (JAMA Oncol. 2022. doi:10.1001/jamaoncol.2022.0039).
While the standard treatment for resectable NSCLC includes anatomic resection with adequate lymph node dissection and adjuvant chemotherapy, many patients with early-stage NSCLC have not received this treatment, possibly affecting the interpretation of the results of adjuvant therapy trials.
In this retrospective cohort study, Kenneth L. Kehl, MD, MPH, Dana-Farber/Partners CancerCare, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues aimed to “ascertain patterns of guideline-concordant treatment among patients enrolled in a US-wide screening protocol for adjuvant treatment trials for resected NSCLC.”
This study included patients with stage IB to IIIA NSCLC enrolled in the Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST) screening study between August 18, 2014, and April 1, 2019, who did not enroll in a therapeutic adjuvant clinical trial. Participants had tumors of at least 4 cm and/or with positive lymph nodes. A total of 2833 patients were selected for this study; 1505 were women (53%), and the mean age was 66.5 years. Statistical analysis was conducted between June 1, 2020, and October 1, 2021.
“Care patterns were ascertained overall and by sociodemographic and clinical factors, including age, sex, race and ethnicity, educational level, marital status, geography, histologic characteristics, stage, genomic variant status, smoking history, and comorbidities,” wrote Dr Kehl and colleagues.
Among participants, 2697 (95%) had anatomic surgical resection, 1513 (53%) had adequate lymph node dissection, 1617 (57%) received any adjuvant chemotherapy, 1237 (44%) received at least 4 cycles of adjuvant platinum-based chemotherapy, and 965 (34%) received any cisplatin-based adjuvant chemotherapy.
“This cohort study found that among participants in a screening protocol for adjuvant clinical trials for resected early-stage NSCLC, just 53% underwent adequate lymph node dissection, and 57% received adjuvant chemotherapy, despite indications for such treatment,” concluded Dr Kehl, adding, “These results may affect the interpretation of adjuvant trials.”
