Adjuvant chemotherapy in stage IB non-small cell lung cancer: if, when, how?

Short review


Adjuvant chemotherapy is established as a standard of care for resectable non-small cell lung cancer. However, this indication remains controversial for the stage IB as the results of the randomized trials and meta-analysis are obscuring on this issue. Moreover, the updated international guidelines do not prescribe the regular use of this strategy in stage IB. The aim of this paper is to review the current evidences regarding the benefit of adjuvant CT in this setting, and to provide clinical hints, which can lend a helping hand to the clinicians and their patients to take the right decision in this particular scenario.


Adjuvant chemotherapy Stage IB Risk factors NSCLC 


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  1. Pisters K, Evans W, Azzoli C, et al. Cancer care ontario and American society of clinical oncology adjuvant chemotherapy and adjuvant radiation therapy for stage I-IIIA resectable non-small-cell lung cancer guideline. J Clin Oncol, 2007; DOI: 10.1200/JCO.2007.14.1226. (
  2. Besse B. Non-small-cell lung cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol, 17 (Suppl 2): ii30–ii31, 2007CrossRefGoogle Scholar
  3. Pignon JP, Tribodet H, Scagliotti GV, et al. Lung Adjuvant Cisplatin Evaluation (LACE): a pooled analysis of five randomized clinical trials including 4 584 patients. J Clin Oncol, 24(Suppl 18): 366s, 2006 (abstract 7008)Google Scholar
  4. Stewart LA, Burdett S, Tierney JF, et al. Surgery and adjuvant chemotherapy (CT) compared to surgery alone in non-small cell lung cancer (NSCLC): a meta-analysis using individual patient data (IPD) from randomized clinical trials (RCT). J Clin Oncol, 25: 397s, 2007 (abstract 7552)CrossRefGoogle Scholar
  5. Martini N, Bains MS, Burt MS, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg, 109: 120–129, 1995PubMedCrossRefGoogle Scholar
  6. Scagliotti GV, Fossati R, Torri V, et al. Randomized study of adjuvant chemotherapy for completely resectd stage I, II or IIIA non-small cell lung cancer. J Natl Cancer Inst, 95: 1453–1461, 2003PubMedGoogle Scholar
  7. The International Adjuvant Lung Cancer study Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med, 350: 351–360, 2004CrossRefGoogle Scholar
  8. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med, 352: 2589–2597, 2005PubMedCrossRefGoogle Scholar
  9. Douillard J-Y, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol, 7: 719–727, 2006PubMedCrossRefGoogle Scholar
  10. Strauss GM, Herndon J, Maddaus MA, et al. Adjuvant chemotherapy in Stage IB non-small cell lung cancer (NSCLC): update of cancer and leukemia group B (CALGB) Protocol 9633. J Clin Oncol, 24 (Suppl 18): 365s, 2006Google Scholar
  11. Roselli M, Mariotti S, Ferroni P, et al. Postsurgical chemotherapy in stage IB nonsmall cell lung cancer: long-term survival in a randomized study. Int J Cancer, 119: 955–960, 2006PubMedCrossRefGoogle Scholar
  12. Niiranen S, Niitamo-Korhonen S, Kouri M, et al. Adjuvant chemotherapy after radical surgery for non-small cell lung cancer: a randomized study. J Clin Oncol, 10: 1927–1932, 1992PubMedGoogle Scholar
  13. Kato H, Ichinose Y, Ohta M, et al. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med, 350: 1713–1721, 2004PubMedCrossRefGoogle Scholar
  14. Nakagawa M, Tanaka F, Tsubota N, et al. A randomized phase III trial of adjuvant chemotherapy with UFT for completely resected pathological stage I non-small-cell lung cancer: The West Japan study group for lung cancer surgery (WJSG), the 4th study. Ann Oncol, 16: 75–80, 2005PubMedCrossRefGoogle Scholar
  15. Hamada C, Tanaka F, Ohta M, et al. Meta-analysis of postoperative adjuvant chemotherapy with Tegafur-Uracil in non–small-cell lung cancer. J Clin Oncol, 23: 4999–5006, 2005PubMedCrossRefGoogle Scholar
  16. Mountain CF. Revision in the international system for staging lung cancer. Chest, 111: 1710–1717, 1997PubMedCrossRefGoogle Scholar
  17. Groome P, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: validation of the proposals for revision of the T,N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of the malignant tumors. J Thorac Oncol, 2: 694–705, 2007PubMedGoogle Scholar
  18. Jones DR, Daniel TM, Denlinger CE, et al. Stage IB non-small cell lung cancers: are they all the same? Ann Thorac Surg, 81: 1958–1962, 2006PubMedCrossRefGoogle Scholar
  19. Kang J-H, Kim KD, Chung KY. Prognostic value of visceral pleura invasion in non-small cell lung cancer. Eur J Cardiothorac Surg, 23: 865–871, 2003PubMedCrossRefGoogle Scholar
  20. Sculier JP. IASLC staging project: prognostic factors. J Thorac Oncol, 2: S229–S230, 2007Google Scholar
  21. Gabor S, Renner H, Popper H, et al. Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 non-small-cell lung cancer. Eur J Cardiothorac Surg, 25: 439–442, 2004PubMedCrossRefGoogle Scholar
  22. Horn L, Sandler A, Putnam J, et al. The rationale for adjuvant chemotherapy in stage I non-small cell lung cancer. J Thorac Oncol, 2: 377–383, 2007PubMedGoogle Scholar
  23. Ardizzoni A, Tiseo M, Boni L, et al. CISCA (cisplatin vs. carboplatin) meta-analysis: An individual patient data meta-analysis comparing cisplatin versus carboplatin-based chemotherapy in first-line treatment of advanced non-small cell lung cancer (NSCLC). J Clin Oncol, 24: 366s, 2006Google Scholar
  24. Fumoleau P, Bremond A, Kerbrat P, et al. for the French Adjuvant Study Group. Better outcome of premenopausal node positive (N+) breast cancer treated with 6 cycles vs. 3 cycles of adjuvant chemotherapy: eight year follow up results of FASG 01. Proc Am Soc Clin Oncol, 18: A 252, 1999Google Scholar
  25. Dediu M, Alexandru A, Median D, et al. Compliance with adjuvant chemoherapy in non-small cell lung cancer. The experience of a single institution evaluating a cohort of 365 patients. J BUON, 11: 425–432, 2006PubMedGoogle Scholar
  26. Gajra A, Newman N, Gamble GP, Kohman LJ, Graziano SL. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol, 21: 1029–1034, 2003PubMedCrossRefGoogle Scholar
  27. Firat S, Bousamra M, Gore E, Byhardt RW. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 52: 1047–1057, 2002PubMedGoogle Scholar
  28. Moro-Sibilot D, Aubert A, Diab S, et al. Comorbidities and Charlson score in resected stage I non-small cell lung cancer. Eur Respir J, 26: 480–486, 2005PubMedCrossRefGoogle Scholar
  29. Potti A, Mukherjee S, Petersen R, et al. A genomic strategy to refine prognosis in early-stage non-small-cell lung cancer. N Engl J Med, 355: 570–580, 2006PubMedCrossRefGoogle Scholar
  30. Zheng Z, Chen T, Li X, et al. DNA synthesis and repair genes RRM1 and ERCC1 in lung cancer. N Engl J Med, 356: 800–808, 2007PubMedCrossRefGoogle Scholar
  31. Bepler G, Li X, Sharma A, et al. Clinical value of tumoral RRM1 and ERCC1 expression for treatment response and therapeutic decisions in NSCLC. ASCO Educational Book. Alexandria: M. Perry, pp. 431–433, 2006Google Scholar
  32. Olaussen KA, Dunant A, Fouret P, et al. DNA repair by ERCC1 in non-small-cell lung cancer and cisplatin-based adjuvant chemotherapy. N Engl J Med, 355: 983–991, 2006PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Medical Oncology DepartmentInstitute of Oncology BucharestBucharestRomania

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