A Population-Based Comparative Effectiveness Study of Chemoradiation Regimens and Sequences in Stage III Non-Small Cell Lung Cancer
A partir des données des registres américains des cancers et de la base Medicare incluant 1 688 patients âgés de plus de 65 ans et atteints d'un cancer du poumon non à petites cellules de stade localement avancé diagnostiqué entre 2002 et 2009, cette étude analyse l'efficacité, du point de vue de la survie globale et de la survie spécifique, de différentes chimiothérapies de consolidation dispensées au moment d'une chimioradiothérapie (durée médiane de suivi : 29 mois)
Objectives : In patients receiving concurrent chemoradiation for locally advanced non-small cell lung cancer (NSCLC), consolidation chemotherapy is frequently given even though several randomized trials have failed to show a benefit. We explored the potential benefits of consolidation chemotherapy using a population-based comparative effectiveness approach. Materials and Methods : Surveillance, Epidemiology, and End Results-Medicare was used to identify patients with Stage III NSCLC aged ≥65 and diagnosed 2002-2009. We selected patients who received concurrent chemoradiotherapy and determined whether they were (concurrent-consolidation) or were not (concurrent-alone) treated with consolidation chemotherapy. Outcomes were overall and cancer specific survival using a conditional landmark analysis approach. Results : 1,688 patients treated with concurrent-alone or concurrent-consolidation were identified with a median follow up of 29 months. Choice of chemotherapy agents did not correlate with outcome. For concurrent-consolidation versus concurrent-alone, the median overall survival was 21 months versus 18 months, respectively (log-rank p = 0.008) and the median cancer specific survival was 23 months versus 19 months, respectively (log-rank p = 0.03). On multivariate analysis, concurrent-consolidation remained associated with improved overall survival (HR 0.85, p = 0.04), and there was a trend for improved cancer specific survival (HR 0.87, p = 0.12). Inverse probability of treatment weighting using propensity scores demonstrated similar findings. Importantly, the benefit of concurrent-consolidation held only for patients treated with carboplatin-taxane but not with cisplatin-etoposide. Conclusion : Survival outcomes were similar among the five most commonly employed platinum-based doublets. We found that patients receiving cisplatin during radiation do not appear to benefit from additional chemotherapy. However, for patients receiving carboplatin, consolidation chemotherapy was associated with improved overall and cancer specific survival.