Investigation on Advanced Non-Small-Cell Lung Cancer among Elderly Patients Treated with Chinese Herbal Medicine versus Chemotherapy: A Pooled Analysis of Individual Data.

Lingling Sun,Lizhu Lin,Hezheng Lai,Paul Fahey,Jing Qiao,Wan Sze Yim,Shutang Wang,Xiaoshu Zhu

doi:10.1155/2019/1898345

Abstract

Purpose Many patients with advanced non-small-cell lung cancer (NSCLC) seek help from Chinese herbal medicine (CHM). The purpose of this study was to investigate the survival between CHM and chemotherapy (CT) treatment of patients aged ≥60 years with advanced Epidermal Growth Factor Receptor (EGFR) wild type NSCLC and Karnofsky Performance Status (KPS) ≥ 60. Methods We extracted individual data of all eligible patients from 1 randomized control trial and 2 cohort studies and performed a pooled analysis. Survival outcomes of patients were compared between CHM group and CT group using Cox regression model stratified for study. Results A total of 486 patients were included in the study, including 262 patients in the CHM group and 224 patients in the CT group. The median overall survival time was 10.9 (95% confidence intervals [CI]: 8.9-13.0) months in CHM group and 9.8 (95% CI: 8.1-11.5) days in CT group (p=0.592). The adjusted hazard ratio (HR) and 95% CI for CHM compared to CT are 0.98 (0.87, 1.10, p=0.751) in the stratified Cox regression model. Stratified analysis showed a trend that previously treated elderly patients with EGFR wild type advanced NSCLC probably gain greater survival benefit from CHM (adjusted HR:0.83, 95% CI: 0.68-1.01, p=0.063). Conclusions There might be no significant difference in survival for elderly patients with advanced EGFR wild type NSCLC between the CHM and CT groups in the current study. And previously treated elderly patients with advanced NSCLC probably receive greater benefit from CHM. However, limited by the design and unpreplanned study hypothesis, the results must be confirmed by randomized control trial before making a conclusion.

Highlights

Lung cancer is the most frequently diagnosed cancer
We found no statistically significant differences in survival between the Chinese herbal medicine (CHM) and CT groups in the univariate stratified Cox model (HR 0.97,95% confidence intervals (CI):0.87-1.09, p=0.588) and in the multivariate model which adjusts for the different potential confounders: smoking status, Karnofsky Performance Status (KPS), stage, and previous treatment (HR 0.98, p=0.751, Table 3)
Based on the pooled analysis, it was found that while there is no evidence of any difference in survival of elderly patients with advanced non-small-cell lung cancer (NSCLC) and KPS ≥ 60 between the CHM and CT groups, the 95% CI indicates that the survival may be anything from 13% better to 10% worse in the CHM group

Summary

Introduction

An estimated 1.8 million new lung cancer cases occurred in 2012, accounting for about 13% of total cancer diagnoses [1]. It is the most common cause of death from cancer worldwide, responsible for nearly one-fifth of all cancer deaths (1.59 million deaths, 19.4% of the total) [2]. Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 80% of all cases [3, 4]. III and IV) [5], and 63% of cases are 65 years of age or older. Demographics that are shifting toward an older population suggest that oncologists will be seeing more elderly patients with NSCLC in years to come [6, 7]

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