Abstract
Treatment outcome data generated in prospective trials are intrinsically biased due to necessary selection criteria. Therefore the results obtained may not reflect the actual impact of current treatment options for an unselected general population. We analysed the treatment modalities and the outcome in 212 consecutive patients with non small cell lung cancer stages IIIB and IV who were seen in a community based oncology group practice between 6/1995 and 6/2006. 93 presented with stage IIIB and 119 with stage IV. Chemotherapy was given to 194/212 patients (92%), 114 patients (54%) received palliative radiation at one point during treatment. Treatment consisted of chemotherapy only in 86 patients (40%) and radiation only in 6 patients. 12 patients received best supportive care only. Patients with stage IIIB have survival rates at 12, 24 and 36 months of 64%, 27% and 21% respectively and for patients with stage IV the survival rates at 12, 24 and 36 months are 40%, 19% and 11% respectively. The median survival for stages IIIB and IV is 16 and 11 months respectively. In a multivariate analysis incorporating the factors stage (IIIB vs. IV), age (<70 vs. >/=70 years) and performance status (WHO 0/1 vs. 2/3) only stage and performance status were independent factors for survival. These retrospective data concerning analysis of survival, response rates and toxicity in a community setting confirm published results of phase II-III studies and indicate that results generated in prospective trials can be transferred into routine care.
Highlights
As part of an internal quality control initiative we evaluated the treatment modalities and the outcome of 212 consecutive pts. with advanced non small cell lung cancer (NSCLC) who were treated in a community based oncology group practice
The therapeutic arsenal for the treatment of advanced NSCLC has significantly improved over the last years
The results obtained in clinical trials are biased due to the scientifically necessary strict inclusion criteria, which exclude e.g. elderly, patients with an impaired performance status or patients with significant comorbidity
Summary
Chemotherapy with platinum based regimen has moderately increased the median survival for patients (pts) with advanced non small cell lung cancer (NSCLC) to 6–9 months.[1,2,3,4,5,6,7] In recent years newer substances as gemcitabine, vinorelbine, taxanes and pemetrexed have widened the treatment options for this patient cohort and resulted in a median survival time of around 10 months.[8,9,10,11,12,13] New drugs as erlotinib targeting the EGFR14 or bevacizumab targeting VEGF15 have further improved the prognosis for these patients. Treatment outcome data generated in prospective trials are intrinsically biased by scientifically necessary selection criteria. As part of an internal quality control initiative we evaluated the treatment modalities and the outcome of 212 consecutive pts. with advanced NSCLC who were treated in a community based oncology group practice
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