6
International adjuvant lung cancer trial (IALT)
➢ Thoracic radiotherapy was optional ➢ Chemotherapy was administered with 60 days ➢ 35% pts in each arm underwent
➢ The lethal treatment-associated toxicity rate in the chemotherapy arm was 0.8%
Outcome data from IALT
Chemotherapy arm Control
P value
Median survival
50.8 months
➢ 69% of the pts assigned to the chemotherapy arm received all 3 cycles.
➢ Stage Ⅲ disease was present in 28%-29% of pts, while the remainder were stage Ⅰor stage Ⅱ
5-year survival rate
44.5%
Median disease-free survival 40.2 months
5-year disease-free survival rate 39.4%
44.4 months <0.03 40.4% 30.5 months <0.003 34.3%
Highlights from the Tenth World Conference on lung
cancer
Tracey L, Evans The oncologist 2004;9:232-238 The conference was held in Vancouver, Canada
ppt made by leeyong
Lethal toxicity rate
0.8%
0
The overall survival hazard ratio for chemotherapy was 0.86 95% CI=0.76-0.98 Absolute 5-year survival benefit of 4.1% Absolute 5-year disease-free survival benefit of 5.1%, and hazard ratio was o.83%
pneuonectomy and the remainder had lobectomy ➢ 39% of pts in each arm had stage Ⅲ,and 46% had scc
International adjuvant lung cancer trial (IALT)
➢ 74% pts received at least 240mg/m2 of DDP;8% pts assigned to the chemotherapy arm received no chemotherapy
➢ There was no benefit to chemotherapy in terms of overall survival or progression-free survival
➢ The overall survival hazard ratio for chemotherapy was 1.02 (95%CI=0.77-1.35)
The Big Lung Trial (BLT)
➢ Large, multicenter study in the UK ➢ All pts with NSCLC received primary therapy
as determined by stage (surgery, radiation, or BSC) ➢ Pts randomized to receive either three 3weekly cycles of DDP-based chemotherapy ➢ DDP/VDS, MMC/IFO/DDP, MMC/VLB/DDP NVB/DDP, or no chemotherapy
The Big Lung Trial (BLT)
➢ In the subgroup of pts receiving BSC as their primary modality, there was a statistically significant survival benefit for chemotherapy
Adjuvant lung project ITALY(ALPI)
➢ 1209 pts with completely resected NSCLC were randomly assigned to received either MMC, VDS, and DDP every 3 weeks for 3 cycles or no chemotherapy
Chemotherapy used in IALT
Adjuvant chemotherapy regimen
% of the pts
Cisplatin 300-400mg/m2 over 3-4 cycles with
e7
vinblastin
11
vindesine
Adjuvant Chemotherapy in nonsmall-cell lung cancer
➢ International adjuvant lung cancer trial (IALT) from 1995-2000 1867 pts from 148 centers in 33 countries pts undergone complete resection of NSCLC chemotherapy arm vs observation arm
Adjuvant lung project ITALY(ALPI)