TY - JOUR
T1 - Platinum-Based Chemotherapy in Older Patients with Non-Small Cell Lung Cancer
T2 - What to Expect in the Real World
AU - Pelizzari, Giacomo
AU - Cortiula, Francesco
AU - Giavarra, Marco
AU - Bartoletti, Michele
AU - Lisanti, Camilla
AU - Buoro, Vanessa
AU - Cattaneo, Monica
AU - Rossetto, Ciro
AU - Rizzato, Simona
AU - Puglisi, Fabio
AU - Macerelli, Marianna
AU - Fasola, Gianpiero
AU - Follador, Alessandro
N1 - Funding Information:
AF declares honoraria for advisory boards from Astrazeneca and MSD, and reports travel expenses from Roche, MSD, and Eisai. FP declares honoraria for advisory boards, activities as a speaker, and travel expenses from Amgen, Astrazeneca, Celgene, Eisai, Eli Lilly, Ipsen, MSD, Novartis, Pierre-Fabre, Pfizer, Roche, and Takeda, and reports research funding from Astrazeneca, Roche, and Eisai. GP, FC, MG, MB, CL, VB, MC, CR, SR, MM, and GF declare that they have no conflicts of interest that might be relevant to the contents of this article.
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: The role of platinum-based chemotherapy (PBC) for the treatment of older patients with non-small cell lung cancer (NSCLC) is still a matter of debate, despite the advent of immunotherapy. Objective: The aim of the study was to identify factors associated with first-line PBC prescription and, secondly, to evaluate the impact of first-line PBC on survival, treatment intensity, risk of hospitalization, and subsequent treatments. Patients and Methods: We reviewed a consecutive series of 474 older patients (age ≥ 70 years) diagnosed with stage IIIB–IV NSCLC at the Department of Oncology, University Hospital of Udine, Italy from January 2009 to March 2017. Results: Overall, 198 patients were deemed eligible, and 65.2% received a PBC. At multivariate analysis, older age was the only factor associated with PBC prescription. In the whole cohort, 46 patients (23.2%) were hospitalized for chemotherapy-related toxicity. Both PBC prescription (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.02–4.87, p = 0.04) and tumor burden (OR 2.39, 95% CI 1.07–5.32, p = 0.03) emerged as independent risk factors for hospitalization. Moving to significant predictors of patterns of care, Eastern Cooperative Oncology Group (ECOG) performance status > 0 was associated with greater risk of first-line failure (OR 2.20, 95% CI 1.15–4.20, p = 0.02), while bone metastases (OR 0.29, 95% CI 0.12–0.69, p = 0.005) and a Charlson Comorbidity Index score ≥ 3 (OR 0.40, 95% CI 0.19–0.84, p = 0.016) independently predicted lower probability of receiving second-line therapy. Remarkably, PBC did not significantly impact overall survival (hazard ratio [HR] 0.83, 95% CI 0.61–1.14, p = 0.24) and progression-free survival (HR 0.95, 95% CI 0.70–1.28, p = 0.73) compared to single-agent chemotherapy (SAC). However, according to an exploratory landmark analysis, patients who received four cycles of treatment or maintenance therapy experienced prolonged overall survival, regardless of PBC use. Conclusions: This study evaluated the real-world use of PBC in older patients with NSCLC, offering an insight into the determinants of its prescription and the pattern of care of these patients. Of note, PBC use was associated with a higher likelihood of hospitalization for chemotherapy-related toxicity, with no benefit on survival compared to SAC.
AB - Background: The role of platinum-based chemotherapy (PBC) for the treatment of older patients with non-small cell lung cancer (NSCLC) is still a matter of debate, despite the advent of immunotherapy. Objective: The aim of the study was to identify factors associated with first-line PBC prescription and, secondly, to evaluate the impact of first-line PBC on survival, treatment intensity, risk of hospitalization, and subsequent treatments. Patients and Methods: We reviewed a consecutive series of 474 older patients (age ≥ 70 years) diagnosed with stage IIIB–IV NSCLC at the Department of Oncology, University Hospital of Udine, Italy from January 2009 to March 2017. Results: Overall, 198 patients were deemed eligible, and 65.2% received a PBC. At multivariate analysis, older age was the only factor associated with PBC prescription. In the whole cohort, 46 patients (23.2%) were hospitalized for chemotherapy-related toxicity. Both PBC prescription (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.02–4.87, p = 0.04) and tumor burden (OR 2.39, 95% CI 1.07–5.32, p = 0.03) emerged as independent risk factors for hospitalization. Moving to significant predictors of patterns of care, Eastern Cooperative Oncology Group (ECOG) performance status > 0 was associated with greater risk of first-line failure (OR 2.20, 95% CI 1.15–4.20, p = 0.02), while bone metastases (OR 0.29, 95% CI 0.12–0.69, p = 0.005) and a Charlson Comorbidity Index score ≥ 3 (OR 0.40, 95% CI 0.19–0.84, p = 0.016) independently predicted lower probability of receiving second-line therapy. Remarkably, PBC did not significantly impact overall survival (hazard ratio [HR] 0.83, 95% CI 0.61–1.14, p = 0.24) and progression-free survival (HR 0.95, 95% CI 0.70–1.28, p = 0.73) compared to single-agent chemotherapy (SAC). However, according to an exploratory landmark analysis, patients who received four cycles of treatment or maintenance therapy experienced prolonged overall survival, regardless of PBC use. Conclusions: This study evaluated the real-world use of PBC in older patients with NSCLC, offering an insight into the determinants of its prescription and the pattern of care of these patients. Of note, PBC use was associated with a higher likelihood of hospitalization for chemotherapy-related toxicity, with no benefit on survival compared to SAC.
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U2 - 10.1007/s40266-020-00785-8
DO - 10.1007/s40266-020-00785-8
M3 - Article
C2 - 32681401
AN - SCOPUS:85088138571
SN - 1170-229X
VL - 37
SP - 677
EP - 689
JO - Drugs and Aging
JF - Drugs and Aging
IS - 9
ER -