Adjuvant Chemotherapy for NSCLC: 2019

[Pages:65]Adjuvant Chemotherapy for

NSCLC: 2019

Dr. Paul Taylor Christie and Wythenshawe Hospitals

Manchester

DISCLOSURE OF INTEREST

T. ravel funding: BMS, Merck, Pierre Fabre

The 20 most common causes of death from cancer, UK 2016

Female Male

number of deaths

Cancer Research UK

cancer survival improves.... but



Cancer Research UK

median survival in trials of advanced NSCLC

14 12 10

8 6 4 2 0 1990

survival

3rd-

histology

benefit

generation

matters

v. BSC platinum doublets plus

doublets

targeted

immunotherapy

1997

BMJ 95

Belani

2004

ECOG 1594

ECOG 4599

2010

2017

Scagliotti Reck

The lung cancer challenge

? Patients present late ? majority have metastatic spread1 ? improvements in treatment of advanced disease have had limited effect on 5-year survival

? low percentage resectable2 ? surgical 5 year survival approximately 40%2

1. LUCADA 2. ANITA

Clinical rationale for adjuvant chemotherapy

Surgical stage (6th ed)

5-yr survival%

IA T1N0M0

67

IB T2N0M0

57

IIA T1N1M0

55

IIB T2N1M0

39

T3N0M0

38

IIIA T3N1M0

25

T1-3N2M0

23

relapse %

local

distant

10

15

10

30

12

40

15

60

1,2,3,4,5

? distant failure more common than local relapse ? clinical and pathological evidence of microdissemination at time of surgery6 ? >80% of recurrences occur within 2 years of surgery6

1. Mountain 2. Feld 84 3. Pairolera 84 4. Martini 80 5. Thomas 90 6. Scagliotti ASCO 2004

Overall survival by pathologic stage according to the seventh edition (A) and the eighth edition (B) groupings using the entire database available for the eighth edition.

Goldstraw J Thorac Oncol 2016

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