Patients Treated With Platinum-Doublet Chemotherapy for Advanced Non-Small-Cell Lung Cancer Have Inferior Outcomes If Previously Treated With Platinum-based Chemoradiation

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• 作者：Ashvin Paramanathan ; Benjamin Solomon ; Marnie Collins ; Michael Franco ; Sarah Kofoed ; Heather Francis ; David Ball ; Linda Mileshkin
• 关键词：Non&ndash ; small-cell lung cancer ; Chemoradiation ; Platinum resistance
• 刊名：Clinical Lung Cancer
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：14
• 期：5
• 页码：508-512
• 全文大小：301 K

文摘

Introduction

The standard of care for locoregionally advanced non-small-cell lung cancer is concurrent platinum-based chemoradiation. Many patients relapse, and subsequent systemic treatment may involve platinum-doublet chemotherapy. It is not known if prior platinum-based chemoradiation influences the response to platinum-based chemotherapy given subsequently for relapse. Therefore, we compared outcomes in these patients with those in patients without prior treatment.

Methods

A retrospective study of patients who had been treated with carboplatin and gemcitabine chemotherapy for de novo metastatic disease or recurrent non-small-cell lung cancer after receiving platinum-based chemoradiation. The primary outcome was progression-free survival (PFS).

Results

A total of 104 patients were analyzed. The median age was 63 years (range, 35-81 years), with 63 (61 % ) patients with newly diagnosed disease and with 41 (39 % ) who were previously treated. The response rate was significantly lower for those previously exposed to chemoradiation (10 % vs. 29 % : P?= .001), as was the median PFS (3.6 months vs. 5.7 months; P?= .002), and median overall survival (OS) (8.6 months vs. 12.1 months; P?= .007). Only the treatment group was a significant predictor (P?= .032) of PFS by univariate analysis. In univariate analysis; sex (men; P?= .04), histology (squamous cell; P?= .04), Eastern Cooperative Oncology Group Performance Status Scale (P?= .002), and treatment group (P?= .023) predicted significantly inferior OS. Multivariate analysis showed that performance status was the only significant predictor of inferior OS.

Conclusion

Outcomes were inferior in patients previously exposed to platinum-based chemoradiation. An approach of stratifying such patients in future trials of chemotherapy should be adopted. Alternative options such as non-platinum-based agents or targeted therapies should be considered in this group.