Is fourth-line chemotherapy routine practice in advanced non-small cell lung cancer?. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Choi, Yong Won; Ahn, Mi Sun; Jeong, Geum Sook; Lee, Hyun Woo; Jeong, Seong Hyun; Kang, Seok Yun; Park, Joon Seong; Choi, Jin-Hyuk; Lee, Soon Young
• Is Part Of: Lung cancer. Volume 87:Issue 2(2015:Feb.)
• Page Start: 155
• Page End: 161
• Publication Date: 2015-02
• Subjects: Non-small cell lung cancer -- Advanced -- Fourth-line chemotherapy -- Overall survival -- Univariate analysis -- Multivariate analysis; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2014.11.016
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Fourth-line therapy in advanced NSCLC is clinical practice in some countries. Median overall survival after the start of fourth-line therapy was 9 months. Good performance status was favorable prognostic factor after fourth-line therapy. Disease control after first-line therapy was associated with favorable outcome. Abstract: Background: Despite advances in palliative chemotherapy, patients with advanced non-small cell lung cancer (NSCLC) eventually experience disease progression during or after completion of first-line chemotherapy, which requires salvage therapy. Second- or third-line therapy in selected patients is recommended in the current guidelines. Although fourth-line therapy is often performed in daily practice in some countries, there are few reports about the clinical benefits of fourth-line therapy. Patients and methods: A retrospective review was conducted on 383 patients who underwent at least first-line palliative chemotherapy for advanced NSCLC (stage IV or stage IIIB/recurrent disease unsuitable for definitive local therapy). Overall survival (OS) and clinicopathological characteristics were analyzed according to the lines of chemotherapy as well as for all study patients. Results: The median OS for all patients after the initiation of first-line therapy was 11 months. The median OS for patients who received fourth- or further-line therapy (77 patients) was longer than that of patients who received third- or lesser-line therapy (27 versus 9 months, p < 0.0001). In multivariate analysis, fourth- or further-line therapy was independently associated with favorable OS (hazard ratio: 0.44, 95% confidence interval: 0.34–0.57, p < 0.0001) along with recurrent disease, female, age <70 years, and ECOG performance status (PS) 0 or 1. Median OS after the start of fourth-line therapy was 9 months. Good PS (ECOG PS 0, 1) at the initiation of fourth-line therapy (10 versus 2 months, p < 0.0001) and disease control (10 versus 7 months, p = 0.011) after first-line therapy were associated with favorable OS in univariate analysis, while poor PS (ECOG PS ≥2) was an independent prognostic factor for poor outcome ( p < 0.0001). Conclusion: The present study suggests that advanced NSCLC patients with good PS after progression from third-line therapy could be considered as reasonable candidates for fourth-line therapy in clinical practice.