Originally published as JCO Early Release 10.1200/JCO.2008.16.4855 on September 22 2008

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Adjuvant Paclitaxel Plus Carboplatin Compared With Observation in Stage IB Non–Small-Cell Lung Cancer: CALGB 9633 With the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups

Gary M. Strauss, James E. Herndon, II, Michael A. Maddaus, David W. Johnstone, Elizabeth A. Johnson, David H. Harpole, Heidi H. Gillenwater, Dorothy M. Watson, David J. Sugarbaker, Richard L. Schilsky, Everett E. Vokes, Mark R. Green

From the Tufts Medical Center; Brigham and Women's Hospital, Boston, MA; Cancer and Leukemia Group B Statistical Center, Duke University Medical Center, Durham; Southeast Cancer Control Consortium Inc, Community Clinical Oncology Program, Goldsboro, NC; University of Minnesota, Minneapolis, MN; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mayo Clinic Jacksonville, Jacksonville, FL; University of Virginia, Charlottesville, VA; and University of Chicago, Chicago, IL

Corresponding author: Gary M. Strauss, MD, MPH, Tufts Medical Center, Division of Medical Oncology, 750 Washington St, Tufts-NEMC, Box 245, Boston, MA 02111; gstrauss{at}tuftsmedicalcenter.org

Purpose Adjuvant chemotherapy for resected non–small-cell lung cancer (NSCLC) is now accepted on the basis of several randomized clinical trials (RCTs) that demonstrated improved survival. Although there is strong evidence that adjuvant chemotherapy is effective in stages II and IIIA NSCLC, its utility in stage IB disease is unclear. This report provides a mature analysis of Cancer and Leukemia Group B (CALGB) 9633, the only RCT designed specifically for stage IB NSCLC.

Patients and Methods Within 4 to 8 weeks of resection, patients were randomly assigned to adjuvant chemotherapy or observation. Eligible patients had pathologically confirmed T2N0 NSCLC and had undergone lobectomy or pneumonectomy. Chemotherapy consisted of paclitaxel 200 mg/m² intravenously over 3 hours and carboplatin at an area under the curve dose of 6 mg/mL per minute intravenously over 45 to 60 minutes every 3 weeks for four cycles. The primary end point was overall survival.

Results Three hundred-forty-four patients were randomly assigned. Median follow-up was 74 months. Groups were well-balanced with regard to demographics, histology, and extent of surgery. Grades 3 to 4 neutropenia were the predominant toxicity; there were no treatment-related deaths. Survival was not significantly different (hazard ratio [HR], 0.83; CI, 0.64 to 1.08; P = .12). However, exploratory analysis demonstrated a significant survival difference in favor of adjuvant chemotherapy for patients who had tumors 4 cm in diameter (HR, 0.69; CI, 0.48 to 0.99; P = .043).

Conclusion Because a significant survival advantage was not observed across the entire cohort, adjuvant chemotherapy should not be considered standard care in stage IB NSCLC. Given the magnitude of observed survival differences, CALGB 9633 was underpowered to detect small but clinically meaningful improvements. A statistically significant survival advantage for patients who had tumors 4 cm supports consideration of adjuvant paclitaxel/carboplatin for stage IB patients who have large tumors.

published online ahead of print at www.jco.org on September 22, 2008

Supported in part by Grants. No. CA08025; CA33601 (S.G.); CA47577; CA16450; CA41287; CA45808; and CA31946 (R.L.S.) from the National Cancer Institute; and by Grant No. U10 CA21661 and Grant No. CA-25224.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, June 5-8, 2004, New Orleans, LA, and at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Editorial

• Adjuvant Chemotherapy for Non–Small-Cell Lung Cancer: A Fading Effect?
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  JCO 2008 26: 5014-5017 [Full Text]

Related Correspondence

• CALGB 9633: An Underpowered Trial With a Methodologically Questionable Conclusion
  Artur Katz and Everardo D. Saad
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