NSCLC: delayed adjuvant chemotherapy still yields benefit

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Takeaway
  • Patients with NSCLC may continue to benefit from adjuvant chemotherapy even when it is administered beyond the traditional postoperative window.
Why this matters
  • In appropriate patients, physicians should consider chemotherapy up to 4 mo after surgery if patients are able to tolerate it.
Study design
  • Retrospective observational study that evaluated 12, 473 treatment-naive patients with NSCLC identified from the National Cancer Database with completely resected tumors and who received adjuvant multiagent chemotherapy between 18 and 127 d after surgery.
  • Funding: Not disclosed.
Key results
  • 3 groups were identified: earlier subgroup (18-38 d in chemotherapy initiation), reference interval (39-56 d), and later subgroup (57-127 d).
  • There was no consistent correlation between mortality risk and timing of adjuvant chemotherapy: 5-y OS, earlier, 53%; reference interval, 55%; later, 53% (log-rank P= .23).
  • Regardless of interval after surgery, adjuvant chemotherapy was associated with a lower mortality risk vs surgery only (earlier HR, 0.672 [P<.001]; reference interval HR, 0.645 [P<.001]; later HR, 0.664 [P<.001]).
  • Predictors of later adjuvant chemotherapy (>56 d) included increased age, nonwhite race, Medicaid/no insurance, lower education, squamous cell carcinoma, undetermined grade, pneumonectomy resection, extended length of stay, and unplanned 30-d readmission.
Limitations
  • Database does not code why chemotherapy was delayed.