Oncology Medical News about Adjuvant chemotherapy, non-small cell lung cancer

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Quality-adjusted time without symptoms or toxicity analysis of adjuvant chemotherapy in non-small cell lung cancer: an analysis of the National Cancer Institute of Canada Clinical Trials Group JBR.10 Trial
Journal of Clinical Oncology, 08/14/09

Jang RW et al. - In a study to aid in treatment decision making in which quality-adjusted survival estimates of the JBR.10 trial were derived using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis, it was concluded that adjuvant chemotherapy in early-stage NSCLC improves quality-adjusted survival despite chemotherapy toxicity.

Methods

Survival curves for treatment (N=242) and observation groups (N=240) were partitioned into 3 health states: time with ≥grade 2 (early or late) chemotherapy-related toxicity (TOX), time in relapse (REL), and time without toxicity or relapse (TWiST).
Q-TWiST = uTOX x TOX + uTWiST x TWIST + uREL x REL, where weights uTOX, uTWIST, and uREL range from 0 to 1.
Threshold utility analysis was performed to test sensitivity of results to changes in the weights.
Weights were derived in an exploratory fashion using different methods, which included use of arbitrary values, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) quality-of-life data prospectively collected in JBR.10, and weights European Quality of Life–Five Dimensions questionnaire collected from early-stage NSCLC pts after resection with discounting for toxicity and relapse.
The α level was .05.

Results

Threshold utility analysis revealed that adjuvant chemotherapy was preferred for all possible weight values for relapse and toxicity (uREL, uTOX), although the result was not always statistically significant.
The adjuvant chemotherapy group had better Q-TWiST in the range of 5 to 6 additional mos, which was statistically significant using all methods.

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