Patients Treated With Platinum-Doublet Chemotherapy for Advanced Non-Small-Cell Lung Cancer Have Inferior Outcomes If Previously Treated With Platinum-based Chemoradiation
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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DOI：
10.1016/j.cllc.2013.03.007
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发表时间：
2013-09-01
影响因子：
3.6
通讯作者：
Mileshkin, Linda
中科院分区：
文献类型：
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作者：
Paramanathan, Ashvin;Solomon, Benjamin;Mileshkin, Linda
我们对接受卡铂和吉西他滨化疗的NSCLC患者进行了一项回顾性研究，以治疗原发性转移性疾病或铂类化疗-放疗后复发性疾病，并确定既往在化疗-放疗期间暴露于铂类的患者的结局较差。这些结果表明，非铂类药物或靶向治疗应考虑在这一组。引言：局部晚期非小细胞肺癌的标准治疗是同时进行含铂类药物的放化疗。许多患者复发，随后的全身治疗可能涉及铂双联化疗。目前尚不清楚既往铂类药物放化疗是否会影响对随后复发的铂类药物化疗的反应。因此，我们比较了这些患者与既往未接受治疗患者的结局。研究方法：一项在接受含铂放化疗后接受卡铂和吉西他滨化疗治疗原发转移性疾病或复发性非小细胞肺癌患者的回顾性研究。主要结局是无进展生存期（PFS）。结果：共分析了104例患者。中位年龄为63岁（范围：35-81岁），63例（61%）患者为新诊断疾病，41例（39%）患者既往接受过治疗。既往接受过放化疗的患者的缓解率显著较低（10% vs. 29%：P= 0.001），中位PFS（3.6个月vs. 5.7个月; P= 0.002）和中位总生存期（OS）（8.6个月vs. 12.1个月; P= 0.007）也是如此。通过单变量分析，只有治疗组是PFS的显著预测因素（P= 0.032）。单变量分析;性别（男性; P= 0.04），组织学（鳞状细胞; P= 0.04），东部肿瘤协作组性能状态量表（P= 0.002），和治疗组（P= 0.023）预测显着劣OS. Multivariate分析表明，性能状态是唯一显着的预测劣OS. Conclusion：结果是劣的患者以前暴露于铂为基础的放化疗。在未来的化疗试验中，应采用对此类患者进行分层的方法。在该组中应考虑替代选择，如非铂类药物或靶向治疗。
We performed a retrospective study of NSCLC patients treated with carboplatin and gemcitabine chemotherapy for either de-novo metastatic disease or recurrent disease after platinum-based chemo-radiation and determined that outcomes are inferior in patients previously exposed to platinum during chemo-radiation. These results suggest that non platinum-based agents or targeted therapies should be considered in this group. 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.