10-Year Survival Similar With Chemoradiation or Surgery in Resectable Advanced NSCLC
Ten-year follow-up of the phase 3 ESPATUE trial found similar overall and progression-free survival with chemoradiotherapy boost or surgery in resectable advanced NSCLC after induction therapy.
Long-term survival following chemoradiation is comparable to that with surgery in patients with resectable, advanced non-small cell lung cancer who have undergone induction therapy, according to 10-year follow-up of a phase 3 trial. At a median follow-up of 145.1 months, there were no significant differences in overall survival between the 2 treatment arms, at a 10-year overall survival rate of 28.3% with chemoradiotherapy boost compared to 29.9% with surgery (P =.70). There was also no significant difference in progression-free survival between the arms (P =.94).
The ESPATUE trial enrolled 246 patients with potentially resectable stage IIA (N2) or selected IIIB NSCLC. Eligible patients had less than 10% weight loss in the 6 months prior to diagnosis, and an Eastern Cooperative Oncology Group performance status of 0 or 1.
The patients underwent induction chemotherapy with three 21-day cycles of cisplatin on days 1 and 8 and paclitaxel on day 1, as well as neoadjuvant radiotherapy at a cumulative dose of 45 Gy, given as 1.5 Gy twice daily, with concurrent cisplatin and vinorelbine administered on days 2 and 9 of radiotherapy.
Of the patients, 161 had tumors that were deemed resectable in the last week of radiotherapy and were randomly assigned to either a risk-adapted chemoradiotherapy boost (n=80) or surgery (n=81). The boost consisted of five 2 Gy fractions per week to a cumulative dose of 20 to 26 Gy, with no treatment break from neoadjuvant radiotherapy. Concurrent chemotherapy, comprising cisplatin on day 2 and vinorelbine on days 2 and 9, was given during the boost.
Competing risks analysis showed that the cumulative rate of deaths from a second lung cancer at 10 years was comparable between the treatment arms, at 7.7% following chemoradiotherapy boost and 8.3% after surgery. The 10-year rate of cumulative deaths from comorbidity events was also similar, at 10.2% and 10.0%, respectively. There were also no significant differences in the cumulative incidence of treatment-related death, deaths from first NSCLC, and deaths from a second non-lung cancer.
The researchers concluded that long-term survival serves as baseline information for ongoing immunotherapy-based stage III protocols, and that no significant differences between local modalities radiochemotherapy and surgery were observed.