Researchers have shown that when compared with surgery alone, giving chemotherapy before surgery to patients with operable non-small cell lung cancer improves 5-year survival by 5%, from 40% to 45%. This is the conclusion of an article published in the Lancet, written by the the NSCLC Meta-analysis Collaborative Group and carried out at the MRC Clinical Trials Unit at UCL.
Although a number of randomised controlled trials have investigated giving chemotherapy before surgery in operable non-small cell lung cancer, there remained uncertainty about the effectiveness of this approach. Most guidelines currently state that more evidence is needed before pre-operative chemotherapy can be recommended. However, these results confirm that giving chemotherapy prior to surgery is a valid treatment option for patients with non-small cell lung cancer.
The Meta-analysis Group of the MRC CTU at UCL, in collaboration with international investigators, undertook a systematic review and meta-analysis of individual participant data, based on 2385 patients from 15 randomised trials. In addition to the benefit seen for survival, pre-operative chemotherapy also led to an absolute improvement in recurrence-free survival of 6% at 5 years and an improvement of 10% at 5 years in time to distant recurrence.
Treatment was beneficial to all patients regardless of their age or stage of disease. However, as the majority of patients included were classified as stage IB, IIB and IIIA, results are most reliable for these stages. 13 out of the 15 trials included in this study reported that side-effects were mild or acceptable and the treatment was generally well tolerated.
These results provide the most complete evidence so far of the benefits of pre-operative chemotherapy for treating non-small cell lung cancer. Trials are still needed to investigate which drugs are best for these patients, how long chemotherapy should be given for, and whether genetic tests might help to predict who could benefit most from pre-operative chemotherapy.