Overview
The optimal treatment for Stage I or Stage IIA non-small cell lung cancer (NSCLC) remains controversial. Radiographic surveillance alone has been recommended for stage I and stage IIA patients after the tumor is removed surgically from the lung, and this standard has been based on the fact that no previous clinical trial has demonstrated a benefit for Stage I or Stage IIA NSCLC patients who receive post-operative chemotherapy. These patients, however, have a substantial risk of death within five years after operation, ranging from approximately 30% to 45%, largely due to metastatic disease that is present immediately after surgery but that is undetectable by conventional methods. Some leading organizations therefore currently recommend post-operative chemotherapy as an alternative standard of care in Stage I or Stage IIA NSCLC patients who are considered to be at particularly high-risk. Up until now, however, there has not been a well-validated means to identify stage I and stage IIA NSCLC patients at high risk of death within five years after operation. A new prognostic tool, a 14-Gene Prognostic Assay, which has been validated and definitively demonstrated in large scale studies to identify intermediate and high-risk stage I or Stage IIA patients with non-squamous NSCLC, is now available to all clinicians through a CLIA-certified laboratory. It is therefore now possible to compare the outcomes of patients randomly assigned to one or the other of these competing standards of care.
Eligibility
Inclusion Criteria:
Written informed consent
Age ≥ 18 years
Able to comply with the protocol, including acceptable candidacy for adjuvant chemotherapy
according to local institutional standards and likely compliance with follow-up for
anticipated length of study (i.e. 5 years from the initiation of enrollment).
Willing to be randomized to chemotherapy.
Histologically documented completely resected (R0) Stage I or IIA non-squamous NSCLC (per
8th edition, TNM staging system)
Adequate tissue sample for the 14-Gene Prognostic Assay
Life expectancy excluding NSCLC diagnosis ≥ 5 years
ECOG performance status 0-1
Completely healed incisions