A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung

Comment in:

Cancer Treat Rev. 2004 Nov;30(7):661-4.

N Engl J Med. 2004 Apr 22;350(17):1777-9.

N Engl J Med. 2004 Aug 12;351(7):713-4; author reply 713-4.

N Engl J Med. 2004 Aug 12;351(7):713-4; author reply 713-4.

A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung.

Department of Surgery, Tokyo Medical University, Tokyo, Japan.

BACKGROUND: In a previous phase 3 trial of adjuvant chemotherapy after resection of non-small-cell lung cancer, a combination of uracil and tegafur (often referred to as UFT) taken orally was shown to prolong survival. A subgroup analysis disclosed that most patients who benefited had pathological stage I adenocarcinoma.

METHODS: We randomly assigned patients with completely resected pathological stage I adenocarcinoma of the lung to receive either oral uracil-tegafur (250 mg of tegafur per square meter of body-surface area per day) for two years or no treatment. Randomization was performed with stratification according to the pathological tumor category (T1 vs. T2), sex, and age. The primary end point was overall survival.

RESULTS: From January 1994 through March 1997, 999 patients were enrolled. Twenty patients were found to be ineligible and were excluded from the analysis after randomization; 491 patients were assigned to receive uracil-tegafur and 488 were assigned to observation. The median duration of follow-up for surviving patients was 73 months. The difference in overall survival between the two groups was statistically significant in favor of the uracil-tegafur group (P=0.04 by a stratified log-rank test). Grade 3 toxic effects occurred in 10 of the 482 patients (2 percent) who actually received uracil-tegafur.

CONCLUSIONS: Adjuvant chemotherapy with uracil-tegafur improves survival among patients with completely resected pathological stage I adenocarcinoma of the lung. Copyright 2004 Massachusetts Medical Society