The study I presented is the IFCT from the French Co-operative Thoracic Intergroup 0302 trial. It’s a randomised phase III multicentre trial which compared two follow-up programmes. Patients were randomly assigned to a minimal or maximal follow-up, that’s a complete resection for non-small cell lung cancer. Minimal follow-up consisted of clinic visits with history, physical examinations and chest X-rays. In the maximal follow-up arm patients also had chest CT scans and in the case of non-adenocarcinoma histology fibre-optic bronchoscopies.
What were some of the clinical outcomes of the comparison looking at median overall survival and benefits or risk going forwards?
The primary endpoint of the trial was overall survival and the study did show that there was no difference in overall survival between both arms, so with the addition of CT scan in the follow-up, with the three year survival rate of 77% in the minimal follow-up arm and 76% in the maximal follow-up arm.
Are there any long term differences?
Yes, the curve. The later parts of the curves diverge so we did an exploratory analysis looking at the landmark analysis at two years. In patients who had disease recurrence at two years there was no difference in survival. However, in patients who had not developed a recurrence at two years CT scan based surveillance seemed to significantly improve survival. The reason why is probably because earlier detection of recurrences within the first two postoperative years did not translate into survival benefit because it reflects aggressive disease. However, beyond two years patients are more at risk of second primary cancer than recurrences and these second primary cancers might be more amenable to curative treatment and might benefit from CT scan detection.
When would you recommend screening?
Looking at the results of the trial we could say that both follow-ups are acceptable. However, doing CT scans every six months is probably of no value, it’s too frequent. Keeping long-term yearly CT scans might be of interest since there might be a benefit of survival over the long term.
Any final thoughts?
We will have more because we had several secondary endpoints including health-related quality of life, just to see whether patients were either reassured or anxious about their CT scans. Also a cost effectiveness analysis and the prognostic value of gene signatures that are currently being analysed.