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Article: A pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited‐stage small cell lung cancer in elderly patients versus younger patients

TitleA pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited‐stage small cell lung cancer in elderly patients versus younger patients
Authors
Keywordsadverse events related to age
chemotherapy
clinical trial
small cell lung cancer
thoracic radiation therapy
Issue Date2019
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/28741
Citation
Cancer, 2019, v. 125 n. 3, p. 382-390 How to Cite?
AbstractBackground: Platinum and etoposide with thoracic radiation followed by prophylactic cranial irradiation constitute the standard treatment for limited‐stage small cell lung cancer (LS‐SCLC). Many patients with LS‐SCLC are elderly with comorbidities. Methods: Individual patient data were collected from 11 phase 2 or 3 trials for LS‐SCLC conducted by the National Clinical Trials Network and activated from 1990 to 2010. The primary endpoint was overall survival (OS); the secondary endpoints were progression‐free survival (PFS), the rate of severe adverse events, and off‐treatment reasons. The outcomes were compared for patients 70 years old or older (elderly patients) and patients younger than 70 years (younger patients). Results: Individual patient data from 1049 younger patients (81%) and 254 elderly patients (19%) were analyzed. In the multivariate model, elderly patients, in comparison with younger patients, had worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.18‐1.63; median OS for elderly patients, 17.8 months; OS for younger patients, 23.5 months) and worse PFS (HR, 1.19; 95% CI, 1.03‐1.39; median PFS for elderly patients, 10.6 months; median PFS for younger patients, 12.3 months). Elderly patients, in comparison with younger patients, experienced more grade 5 adverse events (8% vs 3%; P < .01) and more grade 3 or higher dyspnea (11% vs 7%; P = .03) but less grade 3 or higher esophagitis/dysphagia (14% vs 19%; P = .04) and less grade 3 or higher vomiting (11% vs 17%; P = .01). Elderly patients completed treatment less often, discontinued treatment because of adverse events and patient refusal more frequently, and died during treatment more frequently. Conclusions: Elderly patients with LS‐SCLC have worse PFS and OS and more difficulty in tolerating therapy. Future trials should incorporate assessments of elderly patients, novel monitoring of adverse events, and more tolerable radiation and systemic therapies.
Persistent Identifierhttp://hdl.handle.net/10722/274529
ISSN
2017 Impact Factor: 6.537
2015 SCImago Journal Rankings: 3.188
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorStinchcombe, TE-
dc.contributor.authorFan, W-
dc.contributor.authorSchild, SE-
dc.contributor.authorVokes, EE-
dc.contributor.authorBogart, J-
dc.contributor.authorLe, Q-
dc.contributor.authorThomas, C-
dc.contributor.authorEdelman, MJ-
dc.contributor.authorHorn, L-
dc.contributor.authorKomaki, R-
dc.contributor.authorCohen, H-
dc.contributor.authorGanti, A-
dc.contributor.authorPang, H-
dc.contributor.authorWang, X-
dc.date.accessioned2019-08-18T15:03:30Z-
dc.date.available2019-08-18T15:03:30Z-
dc.date.issued2019-
dc.identifier.citationCancer, 2019, v. 125 n. 3, p. 382-390-
dc.identifier.issn0008-543X-
dc.identifier.urihttp://hdl.handle.net/10722/274529-
dc.description.abstractBackground: Platinum and etoposide with thoracic radiation followed by prophylactic cranial irradiation constitute the standard treatment for limited‐stage small cell lung cancer (LS‐SCLC). Many patients with LS‐SCLC are elderly with comorbidities. Methods: Individual patient data were collected from 11 phase 2 or 3 trials for LS‐SCLC conducted by the National Clinical Trials Network and activated from 1990 to 2010. The primary endpoint was overall survival (OS); the secondary endpoints were progression‐free survival (PFS), the rate of severe adverse events, and off‐treatment reasons. The outcomes were compared for patients 70 years old or older (elderly patients) and patients younger than 70 years (younger patients). Results: Individual patient data from 1049 younger patients (81%) and 254 elderly patients (19%) were analyzed. In the multivariate model, elderly patients, in comparison with younger patients, had worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.18‐1.63; median OS for elderly patients, 17.8 months; OS for younger patients, 23.5 months) and worse PFS (HR, 1.19; 95% CI, 1.03‐1.39; median PFS for elderly patients, 10.6 months; median PFS for younger patients, 12.3 months). Elderly patients, in comparison with younger patients, experienced more grade 5 adverse events (8% vs 3%; P < .01) and more grade 3 or higher dyspnea (11% vs 7%; P = .03) but less grade 3 or higher esophagitis/dysphagia (14% vs 19%; P = .04) and less grade 3 or higher vomiting (11% vs 17%; P = .01). Elderly patients completed treatment less often, discontinued treatment because of adverse events and patient refusal more frequently, and died during treatment more frequently. Conclusions: Elderly patients with LS‐SCLC have worse PFS and OS and more difficulty in tolerating therapy. Future trials should incorporate assessments of elderly patients, novel monitoring of adverse events, and more tolerable radiation and systemic therapies.-
dc.languageeng-
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/28741-
dc.relation.ispartofCancer-
dc.rightsPreprint This is the pre-peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Postprint This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectadverse events related to age-
dc.subjectchemotherapy-
dc.subjectclinical trial-
dc.subjectsmall cell lung cancer-
dc.subjectthoracic radiation therapy-
dc.titleA pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited‐stage small cell lung cancer in elderly patients versus younger patients-
dc.typeArticle-
dc.identifier.emailPang, H: herbpang@hku.hk-
dc.identifier.authorityPang, H=rp01857-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1002/cncr.31813-
dc.identifier.pmid30343497-
dc.identifier.pmcidPMC6340765-
dc.identifier.scopuseid_2-s2.0-85055249450-
dc.identifier.hkuros301761-
dc.identifier.volume125-
dc.identifier.issue3-
dc.identifier.spage382-
dc.identifier.epage390-
dc.publisher.placeUnited States-

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