Poor performance status small cell lung cancer: Who should we treat?

Azam, F.; Wong, Hui Li; Green, J. A.; Marshall, Ernest

doi:10.1200/jco.2011.29.15_suppl.e17502

Cited by 3 publications

(1 citation statement)

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“…A similar retrospective study by Azam et al in 246 patients with SCLC and PS 3 or 4 reported that 80 patients (33%) received chemotherapy (carboplatin þ etoposide in 41 [17%], single agent carboplatin in 32 [13%], oral etoposide in 7 [3%]); the remaining 166 (67%) received BSC. Similar to the results of our study, the authors reported that the median OS was 2 months (95% CI, 1.71-2.28) in the patients managed with BSC, compared to 6 months (95% CI, 3.70-8.29) in patients who received chemotherapy; p < 0.01 [12].…”

Section: Discussionsupporting

confidence: 90%

The role of chemotherapy in patients with small cell lung cancer and poor performance status

et al. 2020

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Background: There are limited data on the role of chemotherapy in patients with small cell lung cancer (SCLC) and poor performance status (PS). Methods: This was a retrospective analysis of a prospective observational study in patients with SCLC and PS 3 or 4. We recorded the initial therapy, symptom improvement, response rate, overall survival (OS), and the impact of various factors on OS. Results: From June 2010 to August 2019, we enrolled 234 patients; 185 (79%) with PS 3 and 49 (21%) PS 4. Initial therapy was best supportive care (BSC) in 49 patients (21%), standard full dose chemotherapy in 31 (13%), and attenuated chemotherapy in 154 (66%). In 89% patients treated with attenuated chemotherapy, symptom-relief occurred at a median of 3 days (IQR, 1-7). Grade 3 and higher toxicities developed in 60% patients treated with initial attenuated chemotherapy, commonly hyponatremia in 39%, neutropenia in 16%, anemia in 11%, and infection in 10%. Grade 3 and higher toxicities as a result of standard chemotherapy occurred in 89% patients treated with upfront standard full dose chemotherapy compared to 69% of patients who received initial attenuated chemotherapy with subsequent treatment escalation. Overall, there were 6 (2.6%) toxic deaths. The response rate to chemotherapy was 77%. The median OS of the patients who received any chemotherapy was significantly longer at 6 months (95% CI, 4.8-7.2) compared to 1 month (95% CI, 0.4-1.6 months) in patients who were managed with BSC, p < 0.001; hazard ratio, 0.39 (95% CI, 0.27-0.56). The disease stage, lactate dehydrogenase level, and receipt of chemotherapy significantly impacted survival. Conclusion: Chemotherapy prolongs survival in patients with SCLC and poor PS. Administering an initial attenuated chemotherapy regimen followed by standard full-dose chemotherapy when the PS improves may lower toxicity and improve tolerance.

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Section: Discussionsupporting

confidence: 90%