Non-small-cell lung cancer (NSCLC) patients who recover slowly from surgery may still benefit from post-operative, or adjuvant, chemotherapy, even if it is delayed up to four months, researchers said in a study published in JAMA Oncology.
Adjuvant chemotherapy is particularly beneficial for NSCLC patients with larger tumors or those whose cancer has spread to the lymph nodes. Many clinicians support starting chemotherapy within six to nine weeks of surgery, but recovery times vary and some patients are not able to begin within the recommended window.
For the retrospective study, “Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery,” researchers at the Yale School of Medicine assessed the data of 12,473 patients with NSCLC in stages 1 to 3. They had lymph node metastasis, large tumors (4 cm or larger), or local extension.
The patients received chemotherapy at different points after surgery — between 18 and 127 days — and differences in survival rates were assessed.
Researchers found that initiating chemotherapy between 57 and 127 days after surgery did not increase the mortality rate, compared to patients who started chemotherapy during the recommended time period.
In addition, patients who received delayed adjuvant chemotherapy had a significantly better survival rate compared to those treated with surgery alone.
“Patients treated surgically for NSCLC continue to benefit from chemotherapy when given outside the traditional postoperative window,” Daniel J. Boffa, MD, associate professor of surgery, member of Yale Cancer Center, and clinical program leader of the Thoracic Oncology Program at Smilow Cancer Hospital, said in a press release.
“Clinicians should still consider chemotherapy in appropriately selected patients who are healthy enough to tolerate it, up to four months after NSCLC surgical resection,” he said. “Further study is warranted to confirm these findings.”