Role of chemotherapy (CT) in performance status 3 and 4 small cell lung cancer (SCLC) patients

Abstract

17026 Background: SCLC is an aggressive malignancy, but has shown high response rate to CT. Performance status (PS) has been recognized as one of the main prognostic factors in SCLC. Sudden and toxic deaths after CT were found to correlate with poor PS. There are few data about risk-benefit ratio of CT in PS 3 and 4 patients, although it has been often used. This study was performed to assess the clinical and laboratorial factors and the outcome of poor PS SCLC patients that received CT in our institution. Methods: A retrospective review was performed at INCA’s tumor registry for SCLC cases diagnosed between January 2001 and December 2004. Patients with pre-treatment ECOG PS 3 and 4 that received CT were selected for analysis. Results: Thirty of 107 SCLC patients (28%) were eligible (73.3% PS 3/ 26.7% PS 4). The median patient age was 64 years and 73.3% were male. Extensive- disease was observed in 83% of these patients. At the first cycle, 21 patients (70%) had to be hospitalized to receive CT and 5 of them (24%) required respiratory support. There were 10 deaths (33.3%) after the first cycle of CT. The median response rate was 77.8% and median overall survival was 2.8 months (138 days for PS 3 and 5 days for PS 4). In this series, there was a statistically significant correlation of PS 4, high serum LDH, hospitalization to start treatment and respiratory support with worse survival. Conclusions: Despite good response rate, poor PS patients, especially PS 4, had high risk of early CT related mortality and had dismal survival. Further studies are required to determine how to best treat these high-risk patients, in particular PS 4 patients, to minimize the early treatment related mortality and to give them the best form of palliation and prolongation of life. No significant financial relationships to disclose.