Patients Treated With Platinum-Doublet Chemotherapy for Advanced Non–Small-Cell Lung Cancer Have Inferior Outcomes If Previously Treated With Platinum-based Chemoradiation

Paramanathan, Ashvin; Solomon, Benjamin; Collins, Marnie; Franco, Michael; Kofoed, Sarah; Francis, Heather; Ball, David; Mileshkin, Linda

doi:10.1016/j.cllc.2013.03.007

Cited by 13 publications

(8 citation statements)

References 10 publications

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“…When locoregional failure after radical-intent CRT for locally advanced NSCLC occurs, treatment frequently focuses on palliative or supportive care. However, chemotherapy in patients previously treated with platinum-based CRT has been reported to have a response rate as low as 10%, 16 and the role of immunotherapy or targeted therapy in this clinical setting still requires investigation. In a small number of patients, high-dose re-irradiation is an option, and in highly selected patients (in particular those with smaller, noncentral tumours), reported survival (median approximately 13–15 months) is comparable with two of the salvage surgery studies included here.…”

Section: Discussionmentioning

confidence: 99%

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review

Dickhoff

Otten

Heymans³

et al. 2018

Ther Adv Med Oncol

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Background:Once recurrent or persistent locoregional tumour after radical chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is identified, few curative-intent treatment options are available. Selected patients might benefit from surgical salvage. We performed a systematic review of the available literature for this emerging treatment option.Methods:A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Publications about persistent or (locoregional) recurrent disease after radical/definitive CRT for locally advanced non-small cell lung cancer were identified.Results:Eight full papers were found, representing 158 patients. All were retrospective series and data were heterogeneous: definition and indication for salvage surgery varied and the median time from radiotherapy to surgery was 4.1–33 months. Complete resection (R0) was achieved in 85–100%, with vital tumour in 61–100%. A large number of pneumonectomies were performed, and additional structures were often resected. Where reported, 90-day mortality was 0–11.4%. Reported survival metrics varied but included median overall survival 9–46 months and 5-year survival 20–75%.Conclusion:There are limited, low-level, heterogeneous data in support of salvage surgery after radical CRT. Based on this, perioperative mortality appears acceptable and long-term survival is possible in (highly) selected patients. In suitable patients (fit, no distant metastases, tumour appears completely resectable and preferably with confirmed viable tumour), this treatment option should be discussed in an experienced multidisciplinary lung cancer team.

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Section: Discussionmentioning

confidence: 99%

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review

Dickhoff

Otten

Heymans³

et al. 2018

Ther Adv Med Oncol

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“…10,11 The response rate to platinum-based chemotherapy for recurrent NSCLC after dCRT was only 10%. 12 Given the prognostic relevance of local failure after dCRT and limited treatment options, the search for further treatment alternatives seems more than justified. Recently published reports on SLS recommend it as a feasible option for local tumor failure in case of absence of the distant tumor.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival after Salvage Surgery for Local Failure after Definitive Chemoradiation Therapy for Locally Advanced Non-small Cell Lung Cancer

Schreiner

Dudek

Lettmaier

et al. 2017

Thorac cardiovasc Surg

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“…A recent review indicated a median progression-free survival (PFS) of 8-13 months for patients with EGFRm-positive NSCLC receiving first-line EGFR TKIs 19 . In contrast, median time to progression or PFS for patients receiving platinum-based doublet chemotherapy combinations was 4-6 months [20][21][22][23] . The National Comprehensive Cancer Network (NCCN) guidelines recommend first-line therapy with an approved TKI for treatment of EGFRm-positive NSCLC 4 .…”

Section: Introductionmentioning

confidence: 99%

Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study

Skinner

Fernandes

Walker

et al. 2017

Journal of Medical Economics

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Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI] ¼ $16,836-$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI ¼ $15,329-$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p < .001). Among patients who received it, anticancer therapy ($11,198; 95% CI ¼ $7,102-$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI ¼ $4,922-$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.ARTICLE HISTORY

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Patients Treated With Platinum-Doublet Chemotherapy for Advanced Non–Small-Cell Lung Cancer Have Inferior Outcomes If Previously Treated With Platinum-based Chemoradiation

Cited by 13 publications

References 10 publications

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review

Long-Term Survival after Salvage Surgery for Local Failure after Definitive Chemoradiation Therapy for Locally Advanced Non-small Cell Lung Cancer

Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study

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