Does Type of Tumor Histology Impact Survival among Patients with Stage IIIB/IV Non-Small Cell Lung Cancer Treated with First-Line Doublet Chemotherapy?

Karen M Clements,David Thompson,Douglas C A Taylor,Katherine P Sugarman,Douglas E Faries,Martin D Marciniak,Craig C Earle,Kathleen Lang,Joshua Nyambose,Gerson Peltz

doi:10.1155/2010/524629

Abstract

Chemotherapy regimens may have differential efficacy by histology in nonsmall cell lung cancer (NSCLC). We examined the impact of histology on survival of patients (N = 2,644) with stage IIIB/IV NSCLC who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G) and cisplatin/carboplatin plus a taxane (C/C+T) identified retrospectively in the SEER cancer registry (1997–2002). Patients with squamous and nonsquamous cell carcinoma survived 8.5 months and 8.1 months, respectively (P = .018). No statistically significant difference was observed in survival between C/C+G and C/C+T in both histologies. Adjusting for clinical and demographic characteristics, the effect of treatment regimen on survival did not differ by histology (P for interaction = .257). There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC.

Highlights

The American Cancer Society estimates that in 2008 there were 215,000 new cases of lung cancer and approximately 162,000 lung cancer deaths, making it the leading cause of cancer mortality in the United States (US) [1]
We examined the impact of histology on survival of patients (N = 2,644) with stage IIIB/IV nonsmall cell lung cancer (NSCLC) who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G) and cisplatin/carboplatin plus a taxane (C/C+T) identified retrospectively in the SEER cancer registry (1997–2002)
There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC

Summary

Introduction

The American Cancer Society estimates that in 2008 there were 215,000 new cases of lung cancer and approximately 162,000 lung cancer deaths, making it the leading cause of cancer mortality in the United States (US) [1]. Recent data from pemetrexed trials have shown that the effect of treatment on survival varied with histology in patients with advanced NSCLC [8,9,10,11,12] These studies have investigated the treatment-by-histology interaction associated with pemetrexed-containing doublets or pemetrexed monotherapy. A third randomized, placebocontrolled study investigating maintenance pemetrexed in advanced NSCLC confirmed the efficacy of pemetrexed in nonsquamous NSCLC [9] Given these results and the lack of studies examining treatment-by-histology interaction in non-pemetrexed-containing chemotherapy regimens in patients with advanced NSCLC, the goal of this retrospective study was to evaluate whether or not histology predicted NSCLC survival outcomes in patients with advanced NSCLC with two commonly prescribed first-line doublet combinations, a platinum agent (cisplatin or carboplatin) plus gemcitabine (C/C+G) and a platinum agent plus a taxane (docetaxel/paclitaxel) (C/C+T), using data from the linked Surveillance, Epidemiology and End Results Program(SEER-) Medicare database

Methods

Study Measures

Results

Discussion