Adjuvant chemotherapy in patients with stage Ib non-small cell lung cancer (NSCLC) improved overall survival (OS) and 5-year OS. Tumor size in these patients ranged from 3 to 7 cm.1

Approximately 16% of all lung cancer cases in the United States are diagnosed at stage I. Stage I is the earliest stage at which the disease can be diagnosed. Surgery is the treatment of choice for patients with early stage, medically operable NSCLC.

This study examined whether patients with early-stage disease benefit from adjuvant chemotherapy following a complete resection the way patients with stage II and III disease benefit. Approximately one-third of patients with stage I NSCLC experience a disease recurrence.

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This exploratory analysis on data from patients with stage Ib NSCLC revealed improved median and 5-year OS for patients with tumors smaller than 4 cm who received adjuvant chemotherapy. Of the 25 267 patients included in the analysis, 4996 (19.7%) received adjuvant chemotherapy. The cohorts were subdivided into 4 groups based on tumor size.

Diagnoses were made between 2003 and 2010, and all patients underwent complete resection. Data was from the National Cancer Database, and staging was from the American Joint Committee on Cancer, 7th edition staging criteria.

“The benefit in patients with tumors [less than] 4 cm strongly suggests a role for chemotherapy in this patient population and counters its current status as an exclusion criterium for adjuvant trials,” wrote the authors.

These results merit an investigation of the clinical benefits and the impact on survival of the use of adjuvant chemotherapy in patients with early stage NSCLC. Current recommendations might need to be revisted.

“There are several limitations to our data including the retrospective nature of the study, with limited information on the reasons for the choice between chemotherapy and observation,” noted the authors.

“Furthermore, there is no data on staging procedures prior to the surgical resection or type of chemotherapy regimens used.”


1. Morgensztern D, Du L, Waqar SN, et al. Adjuvant chemotherapy for patients with T2N0M0 non-small-cell lung cancer (NSCLC) [published online June 8, 2016]. J Thorac Oncol. doi:10.1016/j.jtho.2016.05.022.