Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]):: a randomised controlled trial

被引:1237
作者
Douillard, Jean-Yves [1 ]
Rosell, Rafael
De Lena, Mario
Carpagnano, Francesco
Ramlau, Rodryg
Gonzales-Larriba, Jose Luis
Grodzki, Tornasz
Pereira, Jose Rodrigues
Le Groumellec, Alain
Lorusso, Vito
Clary, Claude
Torres, Antonio J.
Dahabreh, Jabrail
Souquet, Pierre-Jean
Astudillo, Julio
Fournel, Pierre
Artal-Cortes, Angel
Jassem, Jacek
Koubkova, Leona
His, Patricia
Riggi, Marcella
Hurteloup, Patrick
机构
[1] Univ Nantes, Ctr Rene Gauducheau, Dept Med Oncol, F-44805 Nantes, France
[2] Hosp Badalona Germans Trias & Pujol, Catalan Inst Oncol, Barcelona, Spain
[3] IRCCS, Bari, Italy
[4] Osped San Paolo, Bari, Italy
[5] Chorob Pluc & Gruzlicy, Poznan, Poland
[6] Hosp San Carlos, Madrid, Spain
[7] Reg Hosp Lung Dis Thorac Surg, Szczecin, Poland
[8] Inst Canc Arnaldo Vieira Carvalho, Sao Paulo, Brazil
[9] Ctr Hosp P Chubert, Vannes, France
[10] Osped Antonio Cardarelli, Naples, Italy
[11] Ctr Hosp Reg Pasteur, Nice, France
[12] Sismanoglio Gen Hosp, Athens, Greece
[13] Ctr Hosp Lyon Sud, F-69310 Pierre Benite, France
[14] Hop Nord St Etienne, St Etienne, France
[15] Hosp Miguel Servet, Zaragoza, Spain
[16] Med Acad Gdansk, Gdansk, Poland
[17] Inst Rech Pierre Fabre, Paris, France
关键词
D O I
10.1016/S1470-2045(06)70804-X
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Whether adjuvant chemotherapy improves survival of patients with non-small-cell lung cancer (NSCLC) is not known. We aimed to compare the effect of adjuvant vinorelbine plus cisplatin versus observation on survival in patients with completely resected. NSCLC. Methods 840 patients with stage IB-IIIA NSCLC from 101 centres in 14 countries were randomly assigned to observation (n=433) or to 30 mg/m(2) vinorelbine plus 100 mg/m(2) cisplatin (n=407). Postoperative radiotherapy was not mandatory and was undertaken according to every Centre's policy. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN95053737. Findings 367 patients in the chemotherapy group and 431 in the control group received their assigned treatment. 301 (36%) patients had stage IB disease, 203 (24%) had stage II disease, and 325 (39%) had stage IIIA disease. Tolerance to chemotherapy mainly included neutropenia in 335 (92%) patients and febrile neutropenia in 34 (9%); seven (2%) toxic deaths were also recorded. Compliance was greater with cisplatin than with vinorelbine (median dose intensity 89% [range 17-108] vs 59% [17-100]). After a median follow-up of 76 months (range 43-116), median survival was 65(.)7 months (95% CI 47(.)9-88(.)5) in the chemotherapy group and 43(.)7 (35(.)7-52(.)3) months in the observation group. Adjusted risk for death was significantly reduced in patients assigned chemotherapy compared with controls (hazard ratio 0(.)80 [95% CI 0(.)66-0(.)96]; p=0(.)017). Overall survival at 5 years with chemotherapy improved by 8(.)6%, which was maintained at 7 years (8(.)4%). Interpretation Adjuvant vinorelbine plus cisplatin extends survival in patients with completely resected NSCLC, better defining indication of adjuvant chemotherapy.
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页码:719 / 727
页数:9
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