Efficacy and safety of concurrent chemoradiotherapy in ECOG 2 patients with locally advanced non-small-cell lung cancer: a subgroup analysis of a randomized phase III trial

Abstract

Background: There is no consensus on the therapeutic approach to ECOG 2 patients with locally advanced non-smallcell lung cancer (LA-NSCLC), despite the sizable percentage of these patients in clinical practice. This study focused on the efficacy, toxicity and the optimal chemotherapy regimen of CCRT in ECOG 2 patients in a phase III trial. Methods: Patients capable of all self-care with bed rest for less than 50% of daytime were classified as ECOG 2 subgroup. A subgroup analysis was performed for ECOG 2 patients recruited in the phase III trial receiving concurrent EP (etoposide + cisplatin)/PC (paclitaxel + carboplatin) chemotherapy with intensity-modulated radiation therapy (IMRT) or three-dimensional conformal external beam radiation therapy (3D-CRT).Results: A total of 71 ECOG 2 patients were enrolled into the study. Forty-six (64.8%) patients were treated with IMRT technique. The median overall survival (OS) and progression free survival (PFS) for ECOG 2 patients were 16.4 months and 9 months, respectively. No difference was observed in treatment compliance and toxicities between ECOG 2 patients and ECOG 0-1 patients. Within the ECOG 2 group (31 in the EP arm and 40 in the PC arm), median OS and 3year OS were 15.7 months and 37.5% for the EP arm, and 16.8 months and 7.5% for the PC arm, respectively (p = 0.243). The incidence of grade ≥ 3 radiation pneumonitis was higher in the PC arm (17.5% vs. 0.0%, p = 0.014) with 5 radiation pneumonitis related deaths, while the incidence of grade 3 esophagitis was numerically higher in the EP arm (25.8% vs. 10.0%, p = 0.078). Conclusions: CCRT provided ECOG 2 patients promising outcome with acceptable toxicities. EP might be superior to PC in terms of safety profile in the setting of CCRT for ECOG 2 patients. Prospective randomized studies based on IMRT technique are warranted to validate our findings. Trial registration: ClinicalTrials.gov registration number: NCT01494558. (

Long‐term outcome of definitive radiotherapy for locally advanced non‐small cell lung cancer: A real‐world single‐center study in the pre‐durvalumab era

“…The median OS for the Eastern Cooperative Oncology Group (ECOG) 0–1 arm was 30.1 months, compared to 16.4 months for the ECOG 2 arm ( p < 0.001). 27 We also confirmed that PS (KPS score) prior to therapy had a significant impact on survival.…”

Long-term outcome of definitive radiotherapy for locally advanced non-small cell lung cancer: a real-world single-center study

“…The median OS for the Eastern Cooperative Oncology Group (ECOG) 0-1 arm was 30.1 months, compared to 16.4 months for the ECOG 2 arm (P< 0.001). [23] We also con rmed that performance status (KPS score) prior to therapy had a signi cant impact on survival.…”

Chemoradiation followed by adjuvant durvalumab in stage III non–small cell lung cancer: Real‐world comparison of treatment outcomes to historical controls treated with chemoradiation alone

“…Several real‐world adjuvant durvalumab trials included small groups of patients with ECOG performance status ≥2 without identifying these patients at risk for worse outcomes or increased risk of AE. 12 , 15 Bi et al 23 showed no difference in treatment compliance, toxicities, or outcomes between patients with ECOG 2 and ECOG 0–1 performance scores receiving chemoradiation for stage III NSCLC. Two of four patients with ECOG performance scores ≥2 that were included in our durvalumab cohort remain alive and free of disease, suggesting adjuvant durvalumab may also benefit patients with ECOG performance scores ≥2.…”