Optimizing the use of adjuvant chemotherapy in non-small cell lung cancer patients with comorbidities.
Optimizing the use of adjuvant chemotherapy in non-small cell lung cancer patients with comorbidities.
复制标题
DOI：
10.1016/j.currproblcancer.2022.100867
复制
发表时间：
2022-08
影响因子：
2.6
通讯作者：
Sigel, Keith
中科院分区：
文献类型：
--
作者：
Bailey, Stacyann;Wang, Qian;Kong, Chung Yin;Stone, Kimberly;Veluswamy, Rajwanth;Bates, Susan E.;Smith, Cardinale B.;Wisnivesky, Juan P.;Sigel, Keith
患有局部非小细胞肺癌（NSCLC）的退伍军人可能受益于辅助化疗。然而，合并症和其他因素可能会影响这种治疗的危害和益处。在此，我们确定了退伍军人NSCLC、慢性阻塞性肺疾病（COPD）、慢性肾脏疾病（CKD）和/或冠状动脉疾病（CAD）患者辅助化疗的最佳适应症。我们使用来自随机对照试验（RCT）和退伍军人管理局（VA）数据库的数据来增强模拟模型。然后，我们在患有II-IIIA期NSCLC的退伍军人中进行了比较辅助化疗与观察的计算机模拟RCT。在无COPD或CKD的退伍军人中，辅助化疗是最佳策略，无论是否存在CAD，除了> 70岁的鳞状细胞癌患者。相反，大多数没有COPD但患有CKD的退伍军人通过观察进行了最佳管理。患有COPD但无CKD的退伍军人，如果他们年龄≤70岁，患有II-IIIA期腺癌或年龄<60岁，患有II-IIIA期鳞状细胞癌，则可从辅助化疗中获益。辅助化疗仅对年龄<60岁的II-IIIA期腺癌中COPD和CKD的退伍军人有益。患有II-IIIA期鳞状细胞癌、COPD和CKD的退伍军人通过观察进行最佳管理。许多患有合并症的退伍军人通过手术切除后观察进行最佳管理。然而，我们也确定了几组退伍军人，他们的辅助化疗的好处超过了早期毒性的风险。我们的研究结果可以告知患者提供者的讨论，并可能减少医生对辅助化疗在这一人群中的作用的不确定性。
Veterans with locoregional non-small cell lung cancer (NSCLC) may benefit from adjuvant chemotherapy. However, comorbidities and other factors may impact the harms and benefits of this treatment. Here, we identified the optimal indications for adjuvant chemotherapy in Veterans with NSCLC, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and/or coronary artery disease (CAD). We used data from randomized controlled trials (RCTs) and Veterans Administration (VA) databases to enhance a simulation model. Then, we conducted in-silico RCTs comparing adjuvant chemotherapy vs observation among Veterans with stage II-IIIA NSCLC. Among Veterans without COPD or CKD, adjuvant chemotherapy was the optimal strategy regardless of the presence or absence of CAD except for patients > 70 years with squamous cell carcinoma. Conversely, most veterans without COPD but with CKD were optimally managed with observation. Veterans with COPD but without CKD, benefited from adjuvant chemotherapy if they were ≤70 years with stage II-IIIA adenocarcinoma or <60 years with stage II-IIIA squamous cell carcinoma. Adjuvant chemotherapy was only beneficial for Veterans with both COPD and CKD among stage II-IIIA adenocarcinoma <60 years of age. Veterans with stages II-IIIA squamous cell carcinoma, COPD, and CKD were optimally managed with observation. Many Veterans with comorbidities are optimally managed with observation post-surgical resection. However, we also identified several groups of Veterans whom the benefits of adjuvant chemotherapy outweighed the risks of early toxicity. Our findings could inform patient-provider discussions and potentially reduce physicians’ uncertainty about the role of adjuvant chemotherapy in this population.
登录
查看更多内容
影响因子：
3
作者：
Justice, Amy C.;Dombrowski, Elizabeth;Bryant, Kendall
通讯作者：
Bryant, Kendall
老年 I 期 NSCLC 患者肺叶切除术与亚肺叶切除术后的生存率：一项荟萃分析
影响因子：
1.9
作者：
Dong, Siyuan;Roberts, Steven A.;Xu, Shun
通讯作者：
Xu, Shun
影响因子：
20.4
作者：
Moller, Axel;Sartipy, Ulrik
通讯作者：
Sartipy, Ulrik
影响因子：
3
作者：
Patel, Nilang;Golzy, Mojgan;Arora, Pradeep
通讯作者：
Arora, Pradeep
DOI：
10.1097/qad.0000000000001818
发表时间：
2018-06-19
期刊：
AIDS (London, England)
影响因子：
--
作者：
Kong CY;Sigel K;Criss SD;Sheehan DF;Triplette M;Silverberg MJ;Henschke CI;Justice A;Braithwaite RS;Wisnivesky J;Crothers K
通讯作者：
Crothers K