A prognostic model for platinum-doublet as second-line chemotherapy in advanced non-small-cell lung cancer patients.

Hongnan Mo,Xingsheng Hu,Yan Sun,Yan Wang,Ziping Wang,Yuankai Shi,Yutao Liu,Xuezhi Hao,Junling Li,Hongyu Wang,Puyuan Xing,Sheng Yang,Bo Jia,Jianping Xu,Youwu Shi,Lin Wang

doi:10.1002/cam4.689

Abstract

Poor prognosis of advanced non‐small‐cell lung cancer (NSCLC) patients and the promising therapeutic effect of platinum urge the oncologists to evaluate the role of platinum doublet as second‐line chemotherapy and establish the definition of platinum sensitivity in NSCLC. We retrospectively analyzed 364 advanced NSCLC patients who received platinum‐doublet regimens as second‐line chemotherapy after platinum‐based first‐line treatment. Patients were divided into four groups by their time‐to‐progression (TTP) after first‐line chemotherapy: 0–3, 4–6, 7–12, and >12‐month group, respectively. Treatment efficacy of patients' overall survival (OS), progression‐free survival (PFS), and response rate (RR), as well as treatment‐related toxicity, were compared among the four groups. A prognosis score system and a nomogram were established by Cox proportional hazard model, and validated by concordance index (c‐index). Median OS was 14.0, 16.0, 20.0, 25.0 months for patients in the 0–3, 4–6, 7–12, >12‐month group, respectively. Age ≤60 years (P = 0.002), female (P = 0.019), and TTP>12 months (P = 0.003) were independent prognostic factors. Prognostic score was calculated by adding 1 point each for any of the above three indicators, with a c‐index of 0.590 (95% confidential interval [CI], 0.552–0.627). Median OS were equal to 25.0, 16.0, and 11.0 months for best (2–3 points), intermediate (1 point) and worst (0 point) category, respectively (P < 0.0001). A nomogram that integrated patient's age, gender, and TTP for OS has a c‐index of 0.623 (95% CI, 0.603–0.643). Female, younger than 60 years, and TTP greater than 12 months may indicate prolonged survival after platinum‐doublet second‐line chemotherapy in advanced NSCLCpatients.

Highlights

Lung cancer is the leading causes of cancer death worldwide
The four treatment groups were well balanced for patient age, gender, and performance status (PS) (P = 0.242, 0.923, and 0.381, respectively), with the exception of clinical stage and histology: patients whose disease progressed more than 12 months after first-line chemotherapy had less stage IV disease (P = 0.014) and more squamous cell carcinoma (P = 0.000) than the other three groups
Based on the findings reported by some randomized clinical trials, platinum did not add any significant benefit in terms of response rate (RR), progression-free survival (PFS), or overall survival (OS), as compared with pemetrexed or docetaxel alone in advanced Non-small-cell lung cancer (NSCLC) patients who had progressed after first-line platinum-doublet chemotherapy [13, 20]

Summary

Introduction

Lung cancer is the leading causes of cancer death worldwide. Non-small-cell lung cancer (NSCLC) accounts for more than 80% of all lung cancer cases. First-line treatment for stage IIIB and IV NSCLC patients usually consists of a platinum-doublet chemotherapy [1]. All of the advanced NSCLC patients will inevitably experience disease progression after first-line therapy. A substantial part of these patients may still have a good performance status (PS), and be eligible for further anticancer treatment. Certain prognostic factors for second- line treatment of advanced NSCLC include disease stage, PS, female gender, and previous response to first-line treatment [2]

Methods

Results

Conclusion