Multimodality Treatment Sequence Effective in Patients with Stage IIB NSCLC

A national cohort study found that multimodality therapy (MMT) in combination with neoadjuvant therapy was linked to improved overall survival (OS) in patients with stage IIB non-small-cell lung cancer (NSCLC; Ann Thorac Surg. 2020 Dec 19. Epub ahead of print).

“The value of neoadjuvant treatment in combination with resection as multimodality therapy (MMT) for Stage IIB [NSCLC] remains controversial,” wrote Sean M. Stokes, MD, University of Utah School of Medicine, Department of Surgery, Salt Lake City, and colleagues.

Using the National Cancer Database (NCDB), researchers placed stage IIB lung cancer patients in cohorts based on MMT sequence and categorizing them as surgery plus adjuvant chemotherapy (AC), surgery plus adjuvant chemoradiation (ACRT), neoadjuvant therapy plus surgery (NA), surgery-alone, and definitive chemotherapy or chemoradiation (non-surgical).

For this study, the primary comparison was between the NA and AC cohorts. Stokes and colleagues used propensity matching methods to match cohorts who received AC versus NA and multivariable Cox regression to analyze the difference in risk of death between the two.

Of the 10,841 patients included: 2,476 received AC, 854 ARCT, 1,195 NA, while 2,019 received surgery-alone and 4,297 patients were non-surgical. Among the 6,544 surgical patients, 37.8% received AC, 13.% ACRT, 18.3% NA, and 30.9% received surgery alone.

In comparison to those treated with AC, researchers found that non-surgical treatment or surgery-alone (HR, 1.26; 95% CI, 1.14-1.38) were linked to a significantly higher risk of death.

Furthermore, researchers found no difference in risk of death between NA and AC (HR, 1.07; 95% CI, 0.88-1.31).

“MMT, including surgical resection, is associated with improved OS, regardless of treatment sequence with no difference in survival based on a NA or AC approach. The potential benefits of NA over AC to ensure patients complete MMT warrants further prospective investigation,” concluded Dr Stokes et al.—Alexandra Graziano

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