Delaying Adjuvant Chemotherapy Does Not Worsen Outcomes for Patients with Lung Cancer

According to a recent study, published online by JAMA Oncology, post-surgery chemotherapy for patients with non small-cell lung cancer may be delayed for up to four months without a negative effect on outcomes. The current standard period between NSCLC surgery resection and chemotherapy is six to nine weeks.

The number of patient who die from lung cancer is greater than those from colon, breast and prostate cancer combined. Post-surgery, chemotherapy can be a benefit to patients with larger tumors, or with cancer in their lymph nodes. However, post-operative complications can interfere with chemotherapy tolerability. While many clinicians agree that chemotherapy after surgical resection is of benefit, the best window of time for starting that chemotherapy is not well defined.

At Yale, researchers evaluated data from the National Cancer Database, looking at the timing of adjuvant chemotherapy and five-year mortality.

There were a total of 12,473 patients with Stage 1, 2 or 3 disease who received chemotherapy, 3,359 who received adjuvant chemotherapy less than 39 days after surgery, 5,137 who received adjuvant chemotherapy during the reference interval of 39-56 days, and 3,977 who received chemotherapy later than 56 days after surgery.

Researchers also found that factors that could predict later initiation of adjuvant chemotherapy included: age, being nonwhite and having Medicaid or no insurance. An extended initial stay also contributed delayed chemotherapy. As the researchers pointed out, “those who started chemotherapy later were more likely to have a prolonged length of inpatient stay and to be readmitted, suggesting they were more likely to have experienced a challenging postoperative course.”

The authors wrote that “later chemotherapy timing (57-127 days postoperatively) did not consistently compromise survival expectations (compared with 39-56) days. When compared to patients who had only surgery and no chemotherapy, the patients who received delayed chemotherapy had a lower risk of death.

Daniel J. Boffa, M.D., said, “Patients treated surgically for NSCLC continue to benefit from chemotherapy when given outside the traditional postoperative window.”

While these findings do not establish causality, they do suggest the benefit of delayed chemotherapy to patients with NSCLC. Authors noted that it is possible that “a small but significant difference in survival exists based on when chemotherapy is given but it is not able to be appreciated within this data set.”

Boffa, associate professor of surgery at the Yale Cancer Center, coauthor of the study and clinical program leader of Thoracic Oncology Program at Smilow, went on, “Clinicians should still consider chemotherapy in appropriately selected patients who are healthy enough to tolerate it, up to four months after NSCLC surgical resection,” he said. “Further study is warranted to confirm these findings.”

Salazar MC, Rosen JE, Wang Z et al. Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery. JAMA Oncol. Published online January 5, 2017. doi:10.1001/jamaoncol.2016.5829