Mesothelioma and Lung Cancer Patients Still Benefit When Chemotherapy Is Given Months After Surgery

Treatment for pleural mesothelioma, a rare cancer affecting the lining of the lungs, may vary from patient to patient, but nearly all patients are eventually treated with chemotherapy. Chemotherapy is considered the most effective single modality for managing the symptoms of mesothelioma. However, until now, researchers assumed lung cancer patients should begin chemotherapy immediately following surgery for the best results. That may not be the case, according to researchers from Yale University.

In a Jan. 5 press release from Yale Cancer Center, researchers report that non-small cell lung cancer patients who waited up to four months after resection surgery “may still benefit” from the delayed chemotherapy. The researchers set out to define the optimal timing for NSCLC patients to begin chemotherapy after undergoing cancer surgery. The widest recommendation is for patients to begin treatment within nine weeks, however, the Yale team thought postoperative complications should be considered before rushing patients into chemotherapy treatment.

Patients with pleural mesothelioma, a cancer caused by past asbestos exposure that attacks the lining of the lungs, who undergo resection surgery often follow up with chemotherapy and/or radiation treatment to eliminate as much cancer as possible. Recovery from surgery is long and difficult and delaying the start of chemo may help the patient regain their strength before beginning another modality.

Looking at patient data of 12,473 patients with stage I, II, or III NSCLC in the National Cancer Database, the team, led by associate professor of surgery Daniel J. Boffa, MD, evaluated the relationship between the timing of  post-operative chemotherapy and the patients’ five-year mortality.

They found that patients who began a chemotherapy regimen after the nine-week window had “similar outcomes” as patients who started earlier. In addition, the team found that the delay “was associated with a lower risk of death compared to those patients treated only with surgery.”

“Patients treated surgically for NSCLC continue to benefit from chemotherapy when given outside the traditional postoperative window,” said Dr. Boffa.

“These findings indicate that patients who receive adjuvant chemotherapy up to 4 months after surgery may continue to derive benefit from chemotherapy,” the authors concluded. “Clinicians should still consider chemotherapy in appropriately selected patients that are healthy enough to tolerate it, up to 4 months after NSCLC resection.”

Mesothelioma patients often receive similar cancer treatments as NSCLC patients and they benefit from any cancer treatment findings. This finding offers hope to mesothelioma patients who often struggle with quality-of-life issues during care.

The findings were published in the Jan. 5 issue of JAMA Oncology.