WEDNESDAY, Jan. 21, 2004 (HealthDayNews) -- European researchers are reporting the first evidence that chemotherapy after surgery can improve the chances of survival for people with lung cancer.
To an untrained eye, the increased survival rate does not appear striking. Of the 932 patients who had chemotherapy after the cancer was removed surgically, 44.5 percent were alive after an average of 56 months, compared to 40.4 percent of the 932 patients who did not receive the drug treatment, says a report in the Jan. 22 issue of the New England Journal of Medicine. The research was conducted by the International Adjuvant Lung Cancer Trial Collaborative Group.
But, notes Dr. Ronald H. Blum, author of an accompanying editorial, "In terms of relative risk reduction, that does represent the same order of magnitude we see for other standards of care -- for breast cancer and colon cancer, for example."
A key finding of the study is that a two-drug combination is needed and one of the drugs should be cisplatin, a well-established cancer drug, Blum says.
One reason why such results have not been reported until now is that "clinical studies done in the past have not been large enough," Blum says. The newly reported study included patients at 148 medical centers in 33 countries.
But the results also show that "chemotherapy for lung cancer has improved," says Blum, who is director of cancer centers and programs at Beth Israel Medical Center and St. Luke's- Roosevelt Hospital Center in New York City.
Newer cancer drugs that are more effective are now available, he says, and "we need to confirm this study and do additional ones to take advantage of the newer agents."
The European results will affect the way he treats lung cancer patients, Blum says, adding, "This is a new standard of care."
He even uses the word "cure," noting that 39.4 percent of the patients who were given chemotherapy were alive and free of disease five years later, compared to 34.3 percent of those who did not.
But the chemotherapy is not without danger, the report adds. Seven patients died because of the toxic effects of the cancer drugs.
Because preliminary results of the trial were reported last year, chemotherapy already is being offered to many lung cancer patients, says Dr. Naiyer A. Rizvi, an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City. But toxicity is an important concern in selecting patients for the treatment, he says.
"The median age of the patients in the study was 58," Rizvi says. "The mean age of patients in this country is 68. Chemotherapy is inherently a more toxic program that can be hard to deliver to an elderly patient, particularly one who has undergone a large surgical procedure."
But the increase in survival for those patients studied is clear, he says. And Dr. Julie Brahmer, an instructor in oncology at the Johns Hopkins Kimmel Cancer Center in Baltimore, says the finding "is exciting for lung cancer, because now we have something to offer to patients. Until now we didn't have anything."
For selected patients, Brahmer says, "chemotherapy is now standard treatment if a patient recovers properly from surgery."
Lung cancer is the leading cause of cancer deaths in the United States. The American Cancer Society estimates that there will be nearly 174,000 new cases of lung cancer diagnosed in this country in 2004, and more than 160,000 deaths. The overwhelming majority of cases are attributed to smoking.
More information
What you need to know about lung cancer is explained by the National Cancer Institute, which also has a page on chemotherapy.
