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

Abstract

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.

Clinical outcomes of ROS1-positive non-small cell lung cancer with limited access to ROS1-tyrosine kinase inhibitors (TKIs): experience from an Indian tertiary referral centre

“…Most trials have excluded these patients as the survival is poor. We have demonstrated and published the benefit of initial reduced dose chemotherapy in small cell lung cancer patients with poor ECOG PS at presentation [ 22 ].…”

Evaluation of Changes in Activities of Daily Living and Quality of Life of Patients with Bone Metastasis Who Underwent Conservative Therapy through Bone Metastasis Cancer Boards

“…Furthermore, patients with bone metastases may have their PS underestimated due to limitations in physical activity from a musculoskeletal perspective. Improved survival prognosis with chemotherapy, even in patients with low PS sores, such as those with small cell lung cancer, has been previously indicated [ 29 ]. Furthermore, patients with bone metastasis who are admitted to the rehabilitation ward, where chemotherapy treatment is not feasible, often experience a decline in ADL.…”

Small cell carcinoma of the oesophagus: experience of an Indian Tertiary Cancer Centre

“…As per the Global Adult Tobacco Survey, smoking is less common in India, with 19% of men and 2% of women being smokers [ 30 ]. In our earlier studies, we had noted that 10%–15% of our patients with SCLC and 55% of the patients overall with lung cancer were non-smokers [ 31 – 33 ].…”