Adjuvant Uracil–Tegafur Appears Feasible in Older Patients With Resected Early-Stage NSCLC

By: Lisa Astor
Posted: Wednesday, February 4, 2026

Evidence supporting adjuvant chemotherapy in older patients with early-stage non-small cell lung cancer (NSCLC) remains limited, as many prior trials have excluded patients aged 75 years or older. A retrospective analysis from Japan that was published in Cancer Diagnosis & Prognosis now suggests that oral uracil and tegafur, a commonly used adjuvant regimen in this setting, can be administered safely to selected older patients following complete surgical resection.

The study, led by Yoshimasa Akiba, MD, of Toyota Kosei Hospital, evaluated 101 patients with pathologic stage IA3 or IB NSCLC who underwent curative resection between 2017 and 2023. Patients were stratified by age into younger (<75 years; n = 59) and older (≥75 years; n = 42) cohorts. The primary objective was to assess the safety and feasibility of adjuvant uracil and tegafur therapy in older patients, with comparisons of treatment administration, dose intensity, completion rates, and adverse events between age groups.

Adjuvant uracil and tegafur were administered to 63% of younger patients and 62% of older patients, with no statistically significant difference in treatment uptake. Among those who received uracil and tegafur, dose selection and overall safety outcomes were comparable between age groups. Completion of the planned 24-month treatment course occurred in 60% of younger patients and 46% of older patients. This difference did not reach statistical significance. Adverse events of any grade were reported in 51% and 58% of younger and older patients, respectively. Grade 3 or higher events were infrequent in both groups (8.1% vs 7.7%), and no treatment-related deaths were observed.

Notably, in patients treated with the standard uracil and tegafur dose of 400 mg daily, older patients tended to have lower treatment completion rates and a higher incidence of adverse events compared with younger patients, perhaps due to age-related declines in drug metabolism and organ function. This trend was not observed among patients who initiated therapy at a reduced dose.

The authors concluded that age alone should not preclude consideration of adjuvant uracil and tegafur therapy. “In a super-aging society, these findings underscore the importance of considering not only chronological age but also each patient’s overall condition when making decisions regarding adjuvant uracil and tegafur therapy,” Dr. Akiba and colleagues wrote.

Disclosure: The study authors reported no conflicts of interest in relation to this study.

Cancer Diagnosis & Prognosis

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