Platinum-based adjuvant chemotherapy is associated with reduced mortality and increased risk of adverse events in elderly patients with non-small cell lung cancer (NSCLC) and tumor size 4 cm or greater, according to a study published online ahead of print in Annals of Oncology.

Jyoti Malhotra, MD, of the Icahn School of Medicine at Mount Sinai and fellow researchers identified 3,289 patients through the SEER-Medicare database who were diagnosed with stage I NSCLC and had undergone lobectomy.

“The role of adjuvant chemotherapy for NSCLC stage I patients with tumors size 4 cm or greater is not well established in the elderly,”

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They compared overall survival rates and incidence of serious adverse events between patients treated with resection alone, platinum-based adjuvant chemotherapy, or post-operative radiation (PORT) with or without adjuvant chemotherapy.

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In total, 84 percent of patients were treated with resection alone, 9 percent with platinum-based adjuvant chemotherapy, and 7 percent with PORT with or without adjuvant chemotherapy.

In adjusted analysis, adjuvant chemotherapy was associated with improved survival compared with resection alone, while the use of PORT with or without adjuvant chemotherapy was associated with worse outcomes.

Patients who received adjuvant chemotherapy showed a higher rate of serious adverse events compared to those treated with resection alone.


  1. Malhotra, J., et al. “Adjuvant chemotherapy for elderly patients with stage I non-small-cell lung cancer ≥4 cm in size: an SEER–Medicare analysis.” Annals of Oncology. doi: 10.1093/annonc/mdv008. [epub ahead of print]. January 18, 2015.