Recent Trends in Use of Adjuvant Chemotherapy in Elderly Stage II– III Non-Small Cell Lung Cancer

Takefumi Komiya; Emily Powell; Achuta Kumar Guddati


Transl Lung Cancer Res. 2020;9(4):1180-1186. 

In This Article

Abstract and Introduction


Background: Although randomized trials demonstrated survival benefit of adjuvant chemotherapy, previous reports have suggested that its use in elderly populations for early stage non-small cell lung cancer (NSCLC) was infrequent. The current status of adjuvant chemotherapy in this population is unknown.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we examined the incidence of chemotherapy in resected stage II–III NSCLC between 2004 and 2015. Staging was determined according to the American Joint Committee on Cancer (AJCC) 6th version. Cases were grouped by age (20–69, 70–79, and 80+). Trends in use of chemotherapy by age group were assessed by univariate and multivariate analyses.

Results: A total of 35,009 cases were selected as surgically resected stage II–III NSCLC. Use of chemotherapy was 66.9%, 48.2%, 25.0% in age 20–69, 70–79, 80+, respectively. Multivariate analysis demonstrated that younger age [20–69] and recent year [2010–2015] of diagnosis were associated with increased use of chemotherapy. Chemotherapy use increased from 2004 to 2015 by 11.0%, 18.3%, and 11.3% in age 20–69, 70–79, 80+, respectively. In the age 70–79 group, increased use of chemotherapy was greater in stage II (24.3%) than stage III (14.1%). Five-year overall survival in age 70–79 group mildly increased by 7.6% from 2004 to 2011.

Conclusions: This study suggests that use of adjuvant chemotherapy in the elderly population increased primarily in age 70–79. Few patients in the 80+ age group received adjuvant chemotherapy even in recent years.


Since surgically resected non-small cell lung cancer (NSCLC) cases account for the majority of long-term survivors among total lung cancer population, researchers investigated the role of adjuvant chemotherapy in early stage NSCLC for survival outcomes. Between late 1990s and early 2000s, several large phase III trials were conducted internationally.[1–6] Meta-analysis of the studies using cisplatin-based adjuvant chemotherapy demonstrated that adjuvant chemotherapy improves 5-year overall survival by approximately 5% over surgery alone in stage II–III.[7] A subset analysis within stage IB later showed that adjuvant chemotherapy was associated with higher survival rates in patients with tumors ≥4 cm in diameter.[8] Use of adjuvant chemotherapy in this setting became standard management in mid 2000s. Thereafter, use of adjuvant chemotherapy in stage II–III NSCLC increased. Despite hesitancy in prescribing chemotherapy for elderly populations, its use was associated with improved survival in elderly groups in meta-analysis and retrospective studies.[9,10]

However, use of adjuvant chemotherapy remained low in elderly patients between the ages of 70–80 as compared to younger counterparts (age 66–69) according to SEER-Medicare database analysis.[11] Although use of adjuvant chemotherapy was reportedly increased from 2003 to 2008,[12] recent trends after 2010 are unknown. While younger populations have adopted adjuvant chemotherapy, elderly groups in modern ages may not accept cytotoxic chemotherapy in the adjuvant setting due to toxicity concerns. This study focused on identifying recent trends in use of adjuvant chemotherapy in resected stage II–III NSCLC. We present the following article in accordance with the STROBE reporting checklist (available at