Patients with non-small cell lung cancer (NSCLC) who have a delayed recovery from tumor resection may benefit from adjuvant chemotherapy initiated up to 4 months after surgery, a study published in JAMA Oncology has shown.1

Adjuvant chemotherapy is associated with improved survival in various staging scenarios of NSCLC. Variable recovery from NSCLC resection may delay a patient’s ability to tolerate adjuvant chemotherapy; however, it is unclear if time to chemotherapy initiation impacts survival.

To determine the association between adjuvant treatment timing and efficacy, researchers sought to evaluate differences in survival with respect to the time interval between tumor resection and initiation of postoperative chemotherapy.

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For the retrospective observational study, investigators analyzed data from 12,473 treatment-naïve patients with completely resected NSCLC who received postoperative multiagent chemotherapy between 18 and 127 days after surgery included in the National Cancer Data Base. Of those, 25% had stage I disease, 48% had stage II disease, and 27% had stage III disease.

Researchers found that patients had the lowest risk of mortality when chemotherapy was started 50 days (95% CI, 39-56) after NSCLC resection.

Results showed no significant difference in mortality between patients who started chemotherapy 50 days postoperatively and those who initiated chemotherapy between 57 and 127 days (hazard ratio [HR], 1.037; 95% CI, 0.972-1.105; P =.27).

However, the study demonstrated that patients who received chemotherapy during the later interval had about a 33% lower risk of death than those treated with surgery alone (HR, 0.664; 95% CI, 0.623-0.707; P <.001).

Investigators also found that increased age, being nonwhite, having Medicaid or no insurance, lower education, squamous cell carcinoma, undetermined grade, pneumonectomy resection, length of stay greater than 14 days, and unplanned 30-day readmission were significant predictors of delayed initiation of adjuvant chemotherapy.

Although these findings suggest that clinicians should still consider chemotherapy in appropriately selected patients with resected NSCLC who are healthy enough to tolerate it, up to 4 months after surgery, further prospective evaluation is necessary to confirm these findings.


1. Salazar MC, Rosen JE, Wang Z, et al. Association of delayed adjuvant chemotherapy with survival after lung cancer surgery. JAMA Oncol. 2017 Jan 5. doi: 10.1001/jamaoncol.2016.5829. [Epub ahead of print]