ESMO 2017: Phase III IFCT-0302 Trial Assesses Minimal vs CT Scan–Based Follow-up for Completely Resected NSCLC
The optimal follow-up protocol for patients with completely resected non–small cell lung cancer (NSCLC) remains elusive after results of the IFCT-0302 trial, presented at the 2017 European Society for Medical Oncology (ESMO) Congress in Madrid, did not show a difference in overall survival between patients who received computed tomography (CT) scans as part of their follow-up and those who did not (Abstract 1237O). Indeed, the findings suggest regular CT scans, which many guidelines recommend, may not be necessary.
Guideline Recommendations
“Because there is no difference between arms, both follow-up protocols are acceptable,” said study investigator Virginie Westeel, MD, PhD, of Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz in Besançon, France. “A conservative point of view would be to do a yearly CT scan, which might be of interest over the long-term; however, doing regular scans every 6 months may be of no value in the first 2 postoperative years,” she said.
The suggestion is a departure from standard clinical practice, since the majority of medical societies and clinical practice guidelines recommend follow-up visits during which chest CT is considered appropriate every 3 to 6 months in the first 2 years after surgery.
Study Findings
The multicenter study included 1,775 patients with completely resected stage I–II-IIIA NSCLC who completed follow-up visits every 6 months for the first 2 years, and yearly until 5 years postsurgery.
Patients were randomized to a control follow-up, which included clinical examination and chest x-ray, or an experimental follow-up that included the control protocol with the addition of thoracoabdominal CT scan plus bronchoscopy (optional for adenocarcinomas).
After a median follow-up of 8 years and 10 months, overall survival was not significantly different between the groups (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.82–1.09; P = .37) at a median of 99.7 months in the control arm and 123.6 months in the experimental arm.
Three-year disease-free survival rates were also similar, at 63.3% and 60.2% respectively, as were 8-year overall survival rates, at 51.7% and 54.6%.
Commentary
Commenting on the study, ESMO spokesperson Floriana Morgillo, MD, PhD, from the University of Campania Luigi Vanvitelli, Naples, said that although the study does not demonstrate a significant benefit with CT-based follow-up, the trend toward better survival in the CT arm suggests longer follow-up may eventually reveal a benefit of this approach. In the meantime, however, she says CT-based surveillance is still an appropriate option because of its potential for impacting second primary cancers.
“A significant proportion of patients with early-stage NSCLC develop second cancers between the second and fourth year after surgery, and early detection of these with CT-based surveillance beyond 2 years could allow curative treatment,” Dr. Morgillo said. She added that patients must also be informed of the radiation exposure with CT.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
