Progression-free survival at 2 years is a reliable surrogate marker for the 5-year survival rate in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy

Abstract

BackgroundIn locally advanced Non-Small-Cell Lung Cancer (LA-NSCLC) patients treated with chemoradiotherapy (CRT), optimal surrogate endpoint for cure has not been fully investigated.MethodsThe clinical records of LA-NSCLC patients treated with concurrent CRT at Shizuoka Cancer Center between Sep. 2002 and Dec. 2009 were reviewed. The primary outcome of this study was to evaluate the surrogacy of overall response rate (ORR) and progression-free survival (PFS) rate at 3-month intervals (from 9 to 30 months after the initiation of treatment) for the 5-year survival rate. Landmark analyses were performed to assess the association of these outcomes with the 5-year survival rate.ResultsOne hundred and fifty-nine patients were eligible for this study. The median follow-up time for censored patients was 57 months. The ORR was 72%, median PFS was 12 months, and median survival time was 39 months.Kaplan-Meier curve of progression-free survival and hazard ratio of landmark analysis at each time point suggest that most progression occurred within 2 years. With regard to 5-year survival rate, patients with complete response, or partial response had a rate of 45%. Five-year survival rates of patients who were progression free at each time point (3-months intervals from 9 to 30 months) were 53%, 69%, 75%, 82%, 84%, 89%, 90%, and 90%, respectively. The rate gradually increased in accordance with progression-free interval extended, and finally reached a plateau at 24 months.ConclusionsProgression-free survival at 2 years could be a reliable surrogate marker for the 5-year survival rate in LA-NSCLC patients treated with concurrent CRT.

Prognostic Value of Serum Tumor Markers in Patients With Stage III NSCLC Treated With Chemoradiotherapy

“…A 5-year OS rate of 15% in stage III NSCLC patients receiving CCRT has been reported (22,23). Akamatsu et al suggested that the 2-year PFS rate may be a reliable surrogate marker for cure, instead of 5-year OS rate, in patients with stage III NSCLC treated with CCRT (24). In the present study, the 2-year PFS rate in patients with normal tumor marker levels was 56%, and the 5-year OS rate was 67% (Figure 3).…”

Tumor Heterogeneity in Lung Cancer: Assessment with Dynamic Contrast-enhanced MR Imaging

“…To eliminate the long-term observation required for 5-year survival analysis and prognostic determinations, we used 2-year progression-free survival (PFS) as the primary outcome and surrogate of 5-year overall survival in patients with lung cancer (23). PFS was calculated from the time of DCE MR image acquisition to the date of cancer progression or death from any cause.…”

Prospective Study of Patient-Reported Symptom Burden in Patients With Non–Small-Cell Lung Cancer Undergoing Proton or Photon Chemoradiation Therapy

“…Concurrent chemoradiation therapy (CXRT), a standard treatment option for patients with locally advanced non-small cell lung cancer (NSCLC), 1-3 is often associated with acute side effects from the radiation and/or chemotherapy, including both systemic symptoms (e.g., fatigue, sadness, distress, disturbed sleep, drowsiness, lack of appetite) and localized symptoms from radiation-induced toxicities such as esophagitis or pneumonitis (e.g., coughing, sore throat, pain). 4,5 A systematic review revealed that treatment-related toxicities (mainly acute grade 3 or 4 esophagitis and hematological issues such as neutropenia and anemia) from CXRT were more severe than the toxicities from radiotherapy alone or from sequential CXRT.…”