Abstract
IntroductionTreatment-related death (TRD) remains a serious problem in small-cell lung cancer (SCLC), despite recent improvements in supportive care. However, few studies have formally assessed time trends in the proportion of TRD over the past two decades. The aim of this study was to determine the frequency and pattern of TRD over time.MethodsWe examined phase 3 trials conducted between 1990 and 2010 to address the role of systemic treatment for SCLC. The time trend was assessed using linear regression analysis.ResultsIn total, 97 trials including nearly 25,000 enrolled patients were analyzed. The overall TRD proportion was 2.95%. Regarding the time trend, while it was not statistically significant, it tended to decrease, with a 0.138% decrease per year and 2.76% decrease per two decades. The most common cause of death was febrile neutropenia without any significant time trend in its incidence over the years examined (p = 0.139). However, deaths due to febrile neutropenia as well as all causes in patients treated with non-platinum chemotherapy increased significantly (p = 0.033).ConclusionsThe overall TRD rate has been low, but not negligible, in phase III trials for SCLC over the past two decades.
Highlights
Treatment-related death (TRD) remains a serious problem in small-cell lung cancer (SCLC), despite recent improvements in supportive care
Chemotherapy is the mainstay of treatment for small-cell lung cancer (SCLC); it is widely accepted that patients with limitedstage SCLC (LD-SCLC) have prolonged survival with systemic chemotherapy when combined with thoracic irradiation [1,2]
Chemotherapy-related toxicity sometimes leads to treatment-related death (TRD) and often to deterioration in the patient’s quality-of-life
Summary
Treatment-related death (TRD) remains a serious problem in small-cell lung cancer (SCLC), despite recent improvements in supportive care. Chemotherapy is the mainstay of treatment for small-cell lung cancer (SCLC); it is widely accepted that patients with limitedstage SCLC (LD-SCLC) have prolonged survival with systemic chemotherapy when combined with thoracic irradiation [1,2]. Toxicity profile information as well as data on efficacy from phase III trials are essential for a full discussion by physicians and patients in clinical practice. There have been many phase III trials involving SCLC patients investigating the efficacy of chemotherapy, few studies have focused on the frequency or pattern of chemotherapy-related fatal toxicity. The aim of this study was to clarify this issue and its time trends over the last two decades, using data from phase III systemic treatment trials that included about 25,000 patients
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