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Sub-lobar resection as new standard-of-care for cT1aN0 NSCLC?

Presented By
Dr Nasser Altorki, Weill Cornell Medicine, NY, USA
WCLC 2022
Phase 3, CALGB 140503

In a randomised phase 3 trial, sub-lobar resection (SLR) was non-inferior to lobar resection in patients with peripheral cT1aN0 non-small cell lung cancer (NSCLC) and tumour sizes ≤2 cm. According to the authors, these results establish SLR as the standard-of-care for this subset of patients [1].

“Although lobar resection has been the standard-of-care for patients with cT1N0 NSCLC for a long time, recent evidence showed that SLR may be non-inferior to lobar resection in a subset of patients [2],” explained Dr Nasser Altorki (Weill Cornell Medicine, NY, USA). The current phase 3 CALGB 140503 trial (NCT00499330) randomised 697 patients with peripheral T1aN0 NSCLC, with tumours ≤2 cm and without metastases to major hilar or mediastinal lymph nodes, 1:1 to lobar resection or SLR. Disease-free survival (DFS) was the primary outcome of the trial.

After a median follow-up of 7 years, SLR was non-inferior to lobar resection in terms of DFS (HR 1.01; non-inferior one-sided P=0.0176). Corresponding 5-year DFS rates were 63.6% for patients in the SLR group and 64.1% for patients in the lobar resection group. These results were consistent across subgroups. Similarly, overall survival rates did not differ between those who received SLR and those who underwent lobar resection (80.3% vs 78.9%; HR 0.95; one-sided P=0.014). A significant difference in forced expiratory volume in 1 second (FEV1) was observed (4% vs 6% change from baseline in SLR and lobar resection, respectively; P=0.0006), although Dr Altorki commented that this difference may not be clinically relevant.

  1. Altorki N, et al. Lobar or sub-lobar resection for peripheral clinical stage IA = 2 cm non-small cell lung cancer (NSCLC): Results from an international randomized phase III trial (CALGB 140503 [Alliance]). PL03.06, WCLC 2022, Vienna, Austria, 06–09 August.
  2. Saji H, et al. Lancet. 2022;399(10335):1607-1617


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