Around 25% of cases of non-small-cell lung cancers are diagnosed at a localised enough stage to consider removal by surgery, but even so the prognosis remains bleak. The December issue of Prescrire International includes an evaluation of the harm-benefit balance of cytotoxic chemotherapy following surgery.

Current evidence shows that there is no proven benefit to patients with non-small-cell lung cancer measuring 3 cm or less (stage 1A of the TNM classification) undergoing chemotherapy following surgery. The results of several dozen clinical trials on patients with a more advanced but operable cancer (stages 2B, 2 ou 3A) show that post-surgery chemotherapy (cisplatin combined with a vinca alkaloid) increased the proportion of patients surviving 5 years by several percentage points. At the cost of numerous severe adverse effects, which need to be anticipated, including vomiting, haematological disorders and peripheral neuropathies.

In practice, it is reasonable to offer chemotherapy to patients who have undergone surgery for non-small-cell lung cancer of over 3 cm, on condition that the patient accepts the toxicity of this treatment in the hope of prolonging their life. It is also reasonable for patients to choose not to have it, given its limited efficacy and its toxicity.

©Prescrire 1 December 2016

"Resectable non-small cell lung cancer. Adjuvant chemotherapy: slightly longer survival" Prescrire Int 2016; 25 (177): 299-301. (Pdf, subscribers only).