Evolution of induction chemotherapy for non‐small cell lung cancer over the last 30 years: A surgical appraisal. Issue 6 (12th May 2015)

• Record Type: Journal Article
• Authors: Fabre, Elizabeth; Rivera, Caroline; Mordant, Pierre; Gibault, Laure; Dujon, Antoine; Foucault, Christophe; Le Pimpec‐Barthes, Françoise; Riquet, Marc
• Is Part Of: Thoracic cancer. Volume 6:Issue 6(2015)
• Page Start: 731
• Page End: 740
• Publication Date: 2015-05-12
• Subjects: Induction therapy -- lung cancer -- outcome -- surgery; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.12250
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: Induction chemotherapy (ICT) is supposed to reduce the risk of micrometastatic progression and improve resectability of non‐small cell lung cancer (NSCLC). However, best indications for ICT strategy remain unclear in published meta‐analyses. Based on this observation, an evaluation of daily practice is of importance. Therefore, we reviewed indications and efficacy time trends in our 30‐year series. Methods: A database including all patients with NSCLC who underwent surgical resection in two French centers from 1980 to 2009 (n = 5563) was prospectively set and retrospectively reviewed. The indications, clinical and pathologic response rates, and overall survival of ICT patients (n = 732) were analyzed during three successive time‐periods: P1 from 1980 to 1989, P2 from 1990 to 1999, and P3 from 2000 to 2009. Results: The proportion of patients who benefited from ICT increased over time, from 2.8% (n = 35) in P1 to 12.5% (n = 274) in P2, and 20.2% (n = 423) in P3. Indications evolved over time with more N2 patients (n = 211; 49.8%) and less initially unresectable patients (n = 72; 17%) in P3. The clinical response rate between P1 and P2 increased. Five and 10‐year survival rates of ICT patients were 35.2% and 21.5%, respectively. In multivariate analysis, time‐period, age, type of resection, histology, and pathologic response to chemotherapy were significant prognostic factors. Conclusions: Our report on the off‐trial use of induction therapy during the last 30 years demonstrates an increased use of ICT, a progressive focus on N2 disease, and improved response rates.