Chemotherapy improves low performance status lung cancer patients

Abstract

The aim of the present study was to determine the potential benefit of conventional cisplatin-based chemotherapy on patients with advanced nonsmall cell lung cancer (NSCLC) and poor performance status (PS), defined as 60-70 on the Karnofsky scale.Retrospective analysis was carried out of a randomised trial performed in advanced NSCLC where 485 patients received three courses of gemcitabine+ifosfamide+cisplatin induction chemotherapy.Of the patients, 80% had good PS (Karnofsky 80-100) and 20% poor PS. Response rates were 38 and 28%, respectively. Clinical improvement, defined as achieving a good PS during chemotherapy, was observed overall in 25% of the poor PS patients, with rates of 38, 20 and 14%, respectively, in case of response, no change and progression. PS improved more quickly in the responders. Survival of patients with poor PS was significantly worse, but survival of responders was similar, irrespective of the initial poor or good PS. Although nonfatal toxicity was almost similar, there were more toxic deaths (including vascular and cardiac fatalities) in the poor PS patients (9.2 versus 2.1%).In conclusion, combination chemotherapy is associated with clinical improvement in a substantial number of patients with advanced nonsmall cell lung cancer of poor performance status.

Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy

“…In a subgroup analysis based on two randomized parallel trials of mitomycin, ifosfamide and cisplatin administered to ANSCLC patients [31], the most significant HRQOL improvements during chemotherapy was observed in the PS 2 rather than the PS 0/1 group [6]. Clinical improvement, defined as achieving a good PS during combination chemotherapy, is observed in ANSCLC patients with poor PS [32]. The better palliation among PS 2 patients in the present study may reflect their heavier symptom and disease burden and thus a greater potential for palliation.…”

Quality of life after the initial treatments of non-small cell lung cancer: a persistent predictor for patients’ survival

“…Also, there was neither socio-demographical nor clinical characteristics difference between responders vs non responders. Second, previous studies showed poor performance status associated with worse survival and good performance with better survival [15,16,35]. We had information on treatments that were performed after the HRQoL measurement and we assumed, according to standards, that these treatments were prescribed in accordance with each patient’s condition, integrating performance status.…”

Prognostic and predictive factors for lung cancer

“…Therefore, some authors have argued that chemotherapy for stage IV patients should be limited to patients with ECOG performance status 0 or 1 [9]; however, other publications suggest that some patients with PS 2 may also benefit from treatment [10]. Female sex is also a quite reproducible factor and this has recently been confirmed by a meta-analysis [11].…”