Treatment and outcome of patients with metastatic NSCLC: a retrospective institution analysis of 493 patients

Abstract

BackgroundMost patients with metastatic non-small cell lung cancer (NSCLC) will face treatment with systemic therapy. Current clinical studies are demonstrating improvements in chemotherapy and overall survival. However, it remains unclear whether these results are translated into clinical practice.MethodsWe reviewed all stage IV NSCLC patients without second malignancies that were diagnosed from 2004 to 2006 at our institution. 493 consecutive patients were included into this retrospective analysis and were followed-up until end of 2011.Results352 patients (71.4%) received systemic therapy for up to 7 lines. For most patients, adjustments of dosages or applications had to be made at some point of the treatment, but the total applied dose remained generally close to the intended dose. The best disease control (BDC) rate decreased with increasing therapy lines from 59.7% to about 35%. Patients with palliative local therapy but no systemic treatment demonstrated inferior survival (median 2.9 versus 8.7 months, p < 0.001). The median interval between last treatment and death was 50 days and 15 days for chemotherapy and anti-EGFR therapy, respectively. BDC to the previous therapy lines was predictive for improved BDC to third- but not second-line therapy. Performing multivariate analysis, BDC to previous therapy, never-/ former-smoking status, and age > 70 years were associated with improved survival performing third-line therapy.ConclusionsStage IV NSCLC patients may receive substantial systemic therapy resulting in response and median survival rates that are comparable to data from clinical studies. However, preselection factors are increasingly important to improve therapy outcome and life quality.

Real-world treatment patterns for patients receiving second-line and third-line treatment for advanced non-small cell lung cancer: A systematic review of recently published studies

“…Additionally, the data confirm the limited survival benefit of treatments that were available at the time these studies were conducted. An exception to this was the lower survival among second-line patients in Germany reported by Zietemann and Duell compared with outcomes reported from other European studies with similar outcome definitions [19, 22]. No explicit reason for the lower survival reported in this study was identified based on patient and tumor characteristics, or the study setting.…”

“…Five studies reported OS from time of metastatic NSCLC (mNSCLC) diagnosis [19, 20, 21, 23, 26]. Three of these studies reported the median OS among patients with advanced NSCLC who received second-line therapy.…”

¹²⁵I&nbsp;brachytherapy of locally advanced non-small-cell lung cancer after one cycle of first-line chemotherapy：a comparison with best supportive care

“…The expected survival time of patients with locally advanced NSCLC is less than 6 months if patients did not receive any medical intervention 6,7. For patients with stage III NSCLC, treatments are delivered to the patients with a goal of achieving a local tumor control and preventing the systemic metastases 8. Chemotherapy, particularly combined with external beam radiotherapy, can offer some benefits of prolonging overall survival (OS) to the patients with advanced NSCLC 9–11.…”

The lung cancer patient, the pneumologist and palliative care: a developing alliance

“…For example, inadequate multidisciplinary team collaboration may become manifest when observing active tumour-specific treatment during the end-of-life period. Several retrospective studies investigated this issue [158][159][160][161][162][163], with some reporting oncological treatment rates between 14.2% and 20% in lung cancer patients within the last 2 weeks of life [158,163]. While the ASCO Quality Oncology Practice Initiative has recommended the lowest possible rate of chemotherapy as one quality objective in end-of-life care [164], the problem remains unsolved regarding under which circumstances such oncological treatments are still meaningful and when they are already futile or even harmful in individual patients.…”