Study backs chemotherapy for lung cancer

By DANIEL Q. HANEY : AP Medical Editor
Jun 2, 2003 : 3:49 pm ET

CHICAGO -- A large international study has shown for the first time that offering chemotherapy after surgery can modestly improve the survival of people with early-stage lung cancer.

Even though the benefit is small, doctors say the discovery is important, both because lung cancer is such a grim diagnosis and because it is so common. It is the No. 1 cancer killer, diagnosed in 1.2 million people around the world each year, and 85 percent of victims die of the disease.

Chemotherapy after surgery is standard for treatment of breast and colon cancer. But until now, there has been no convincing evidence that it changes the course of lung cancer. Doctors do offer chemotherapy to patients, but the treatment is typically intended to ease symptoms rather than delay death.

The latest study, released Monday, suggests lung cancer patients do have another treatment option, if their tumors are found early and can be removed with surgery. A follow-up round of chemotherapy improves their survival by several months.

Dr. Thierry Le Chevalier, who directed the study, said the results mean chemotherapy should be a routine option for patients who have surgery for early lung cancer.

"The benefit reported could prevent annually around 7,000 deaths worldwide," he said at a meeting in Chicago of the American Society of Clinical Oncology.

Several doctors agreed that the results will have a major impact, although some questioned whether the change will be immediately embraced by all specialists.

"This will change the way lung cancer is treated," predicted the society's president, Dr. Paul Bunn, a lung cancer specialist at the University of Colorado.

Dr. Bruce Johnson of Harvard's Dana-Farber Cancer Institute said, "I will go home and discuss the study with patients and offer them this therapy."

However, Dr. Nassar Hanna of Indiana University noted that several smaller studies have tried and failed to prove that chemotherapy does any good after lung cancer surgery.

"I don't think there will be an across-the-board change in practice, although many will be swayed," Hanna said.

The study was conducted on patients with non-small-cell lung cancer, by far the most common kind, that was confined to the lungs or had spread only to nearby lymph nodes. About one-third of such patients are considered good candidates for surgery. Many patients cannot have surgery because they are not well enough to tolerate the operation, which typically takes out 20 percent of the lung, or the disease has already spread to the lymph nodes in the neck and opposite side of the chest.

Doctors enrolled 1,867 patients at 148 hospitals in 33 countries. They were randomly assigned to get an operation alone or surgery plus chemotherapy. The treatment regimens included the drug cisplatin plus a variety of other standard chemotherapy medicines.

After five years, 45 percent of patients getting chemotherapy were still alive, compared with 40 percent of those getting only surgery. Average survival was 51 months for the chemotherapy patients and 44 months for the comparison group.

Cisplatin can carry serious side effects, including a drop in white blood cells that leaves patients open to infection.

Another study presented at the meeting Monday raises the possibility that people taking cholesterol-lowering drugs to keep their hearts working smoothly may also lower their risk of cancer. Millions already take the drugs, called statins, and the latest work suggests they may be getting an unexpected benefit.

Matthijs Graff, a pharmacist at the University of Amsterdam, compared statin use in 3,219 people with cancer and 16,976 without. The data were drawn from pharmacy and hospital records in eight Dutch cities.

He found that those taking statins had a 20 percent lower risk of cancer. However, the benefit did not show up until people had taken the pills for at least four years.

Some other studies have shown similar results. However, Graff cautioned that people should not take the prescription drugs solely to lower their cancer risk until more research is done to prove statins truly do this.

Editor's note: EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

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