Which patients are suitable?

The majority of randomized adjuvant trials studied patients with resected stage II-III NSCLC.1The role of adjuvant chemotherapy in resected stage I NSCLC will be addressed in a later section. In a recent meta-analysis of individual patient data from 34 trial comparisons and 8447 patients, an absolute survival benefit of 4% (from 60% to 64%) at 5 years was seen with the addition of adjuvant chemotherapy with a hazard ratio [HR] of 0.86 (95% CI 0.81-0.92, p<0.0001).1There is no local data available on the benefits of adjuvant chemotherapy in patients with NSCLC.

In the recent meta-analysis, it appeared there was an increasing relative effect of adjuvant chemotherapy on the improvement of performance status but it was noted very few patients with a performance status of 2 were included in the studies.1Although age itself was not a contra-indication foradjuvant chemotherapy2, in a larger analysis, no other subgroups defined by age, gender or histology benefited from adjuvant chemotherapy. 1

Recommendations on Patient Inclusion

Following discussion, the Workgroup has unanimously expressed support for the adoption of SIGN guidelines.

Recommendations are as follows:

1. The risks and benefits of postoperative systemic anticancer therapy should be discussed with each patient (Grade of recommendation: Good practice point).

2. Patients with good performance status (PS 0-1) and completely resected pathological Stage II-III NSCLC with negative margins should be offered platinum based postoperative systemic anticancer therapy (A).