Many patients with early-stage non-small cell lung cancer (NSCLC) are not receiving standard treatment, according to a study published in JAMA Oncology.

A little more than half of patients studied underwent adequate lymph node dissection and received adjuvant chemotherapy. According to researchers, this lack of guideline-concordant care “may affect the interpretation of adjuvant trials.”

“Understanding the quality of standard therapy delivered to patients with early-stage NSCLC is critical to interpreting the results of clinical trials of targeted therapy or immunotherapy,” the researchers wrote. “Such trials might be more likely to demonstrate apparent benefits of novel, expensive therapies when the initial course of standard therapy has left micrometastatic disease behind.”

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The researchers conducted this retrospective study in patients who were enrolled in ALCHEMIST ( Identifier: NCT02194738), a screening trial for patients with completely resected NSCLC. In this trial, participants undergo biomarker testing to inform eligibility for specific adjuvant therapy trials. Patients who enrolled in an adjuvant therapy trial after screening were not included in the current analysis.

The analysis included 2833 patients with stage IB to IIIA NSCLC. All patients had tumors measuring at least 4 cm and/or positive lymph nodes.

Most patients (95%) underwent anatomic resection, but only 53% had adequate lymph node dissection according to National Comprehensive Cancer Network criteria.

Furthermore, 57% of patients received adjuvant chemotherapy, with 44% receiving at least 4 cycles of platinum-based chemotherapy and 34% receiving cisplatin-based chemotherapy. Among patients with stage IIIA disease, 65% received adjuvant chemotherapy.

“This study reinforces the importance of optimizing delivery of proven therapies to patients with cancer and the importance of understanding the quality of standard treatment delivered when interpreting results of therapeutic clinical trials of novel, costly therapies,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Kehl K, Zahrieh D, Yang P, et al. Rates of guideline-concordant surgery and adjuvant chemotherapy among patients with early-stage lung cancer in the US ALCHEMIST Study (Alliance A151216). JAMA Oncol. Published online March 17, 2022. doi:10.1001/jamaoncol.2022.0039