The results of the National Cancer Institute of Canada Clinical Trials Group JBR.10 showed that adjuvant therapy with vinorelbine and cisplatin after removal of stage 1B-II non-small-cell-lung cancer significantly improved overall and relapse-free survival, Dr. Natasha B. Leighl, from the University of Toronto, and colleagues note.
“However,” they add, “many patients either are not referred for chemotherapy or decline treatment. To aid in treatment decision making, quality-adjusted survival estimates of the JBR.10 trial were derived using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis.”
In the new study, 242 treated patients and 240 observation controls had their survival curves divided into three health states: time with grade 2 or higher chemotherapy-related toxicity, time in relapse, and time without toxicity or relapse. These states were then used to calculate Q-TWiST.
The results indicate that regardless of the time with toxicity or time in relapse, adjuvant chemotherapy provided the best quality-adjusted survival, although, as the authors note, the finding was not always statistically significant.
Compared with the observational group, the chemotherapy group experienced 5 to 6 additional months of quality-adjusted survival. The benefit was statistically significant on all analytical methods used.
The findings “should help mitigate concerns, expressed by lung cancer patients considering adjuvant chemotherapy, about the adverse impact of treatment on their quality of life,” the researchers state. The results may also help patients make better informed treatment decisions, they add.
J Clin Oncol 2009;27:3868-3874.