What is the recommended adjuvant therapy for a patient with stage T2a N0 adenocarcinoma (a type of non-small cell lung cancer) of the lung?

From the Guidelines

For T2aN0 adenocarcinoma of the lung, adjuvant chemotherapy is recommended following complete surgical resection, as it provides approximately a 5% absolute improvement in 5-year survival. The standard regimen consists of a platinum-based doublet, typically cisplatin 75 mg/m² on day 1 plus vinorelbine 25-30 mg/m² on days 1 and 8, repeated every 3 weeks for 4 cycles 1. Alternative regimens include cisplatin with pemetrexed, carboplatin with paclitaxel, or cisplatin with gemcitabine.

Some key points to consider when deciding on adjuvant chemotherapy for T2aN0 adenocarcinoma of the lung include:

• The patient's overall health and ability to tolerate chemotherapy
• The presence of any comorbidities that may affect the patient's ability to receive chemotherapy
• The patient's performance status and ability to recover from surgery
• The potential benefits and risks of adjuvant chemotherapy, including the potential for improved survival and the risk of side effects such as myelosuppression, nausea, fatigue, and neuropathy 1.

Treatment should begin within 6-8 weeks after surgery when the patient has adequately recovered. Before starting treatment, patients should undergo baseline laboratory testing including complete blood count, comprehensive metabolic panel, and assessment of renal function. Regular monitoring during treatment is essential to manage potential side effects.

It's worth noting that the evidence for adjuvant chemotherapy in stage IB (T2aN0) disease is not as strong as it is for stage II and III disease, and the decision to use adjuvant chemotherapy should be made on a case-by-case basis, taking into account the individual patient's characteristics and preferences 1.

From the FDA Drug Label

1. 1 Adjuvant Treatment of EGFR Mutation-Positive Non-Small Cell Lung Cancer (NSCLC) TAGRISSO is indicated as adjuvant therapy after tumor resection in adult patients with non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test

• Adjuvant therapy with osimertinib is indicated for patients with EGFR mutation-positive NSCLC after tumor resection.
• The patient has T2aN0 adenocarcinoma lung, but there is no information about EGFR mutation status.
• Key points to consider:
  • EGFR mutation status is required for patient selection.
  • Osimertinib is indicated for adjuvant therapy in patients with EGFR exon 19 deletions or exon 21 L858R mutations.
• Based on the information provided, osimertinib may be considered as adjuvant therapy for the patient with T2aN0 adenocarcinoma lung if the tumor has EGFR exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test 2.

From the Research

Adjuvant Therapy for T2aN0 Adenocarcinoma Lung

• The benefits of adjuvant chemotherapy for patients with T2aN0 stage IB lung adenocarcinoma remain controversial 3.
• A retrospective cohort study found that adjuvant chemotherapy improved overall survival (OS) and cancer-specific survival (CSS) in patients with tumors >3 cm, but <=4 cm 3.
• However, for patients with tumors <=3 cm with visceral pleural invasion (VPI), adjuvant chemotherapy had no survival benefit 3.
• Another study found that platinum-based adjuvant chemotherapy might offer better survival than observation alone for surgically treated stage IB NSCLC, particularly for patients with larger tumors (>3.2 cm) and good performance status 4.
• A comparison of adjuvant chemotherapeutic regimens found that paclitaxel plus carboplatin (PC) and vinorelbine plus cisplatin (NP) had comparable efficacy, but different adverse event profiles 5.
• The effectiveness of adjuvant carboplatin-based chemotherapy compared to cisplatin in non-small cell lung cancer was found to be similar, with no significant differences in overall survival, progression-free survival, and toxicity 6.

Subgroup Analysis

• Patients with larger tumors (>3 cm) and good performance status may benefit from platinum-based adjuvant chemotherapy 4.
• Patients with tumors >3 cm, but <=4 cm, may benefit from adjuvant chemotherapy, regardless of the presence or absence of risk factors 3.
• The subgroup analysis of patients receiving adjuvant PC or NP regimens found that relapse-free survival was comparable between the two groups across all variables 5.

Chemotherapeutic Regimens

• Platinum-based adjuvant chemotherapy, such as vinorelbine plus cisplatin (NP), may be effective for stage IB NSCLC 4.
• Paclitaxel plus carboplatin (PC) may be considered as an alternative adjuvant chemotherapy regimen for resected NSCLC 5.
• The combination of atezolizumab with bevacizumab, carboplatin, and paclitaxel (ABCP) may provide clinical benefit to patients with non-squamous NSCLC, including those with EGFR mutations 7.