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Tumor Biology

, Volume 36, Issue 12, pp 9641–9648 | Cite as

Is second-line systemic chemotherapy beneficial in patients with non-small cell lung cancer (NSCLC)? A multicenter data evaluation by the Anatolian Society of Medical Oncology

  • Hatice Odabas
  • Arife Ulas
  • Kubra Aydin
  • Mevlude Inanc
  • Asude Aksoy
  • Dogan Yazilitas
  • Mehmet Turkeli
  • Sinemis Yuksel
  • Ali Inal
  • Ahmet S. Ekinci
  • Alper Sevinc
  • Nebi S. Demirci
  • Mukremin Uysal
  • Necati Alkis
  • Faysal Dane
  • Mehmet Aliustaoglu
  • Mahmut Gumus
Research Article

Abstract

Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19–86). Docetaxel was the most commonly used (20.9 %, n = 189) single agent, while gemcitabine–platinum was the most commonly used (6.7 %, n = 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2–3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0–7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months (p = 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors (p = 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.

Keywords

Hemoglobin level Non-small cell lung cancer Second-line treatment Prognostic factors Survival 

References

  1. 1.
    Di Maio M, Lama N, Morabito A, Smit EF, Georgoulias V, Takeda K, et al. Clinical assessment of patients with advanced non-small-cell lung cancer eligible for second-line chemotherapy: a prognostic score from individual data of nine randomised trials. Eur J Cancer. 2010;46(4):735–43.CrossRefPubMedGoogle Scholar
  2. 2.
    Shepherd FA, Dancey J, Ramlau R, Mattson K, Gralla R, O'Rourke M, et al. Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol. 2000;18(10):2095.CrossRefPubMedGoogle Scholar
  3. 3.
    Dancey J, Shepherd FA, Gralla RJ, Kim YS. Quality of life assessment of second-line docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy: results of a prospective, randomized phase III trial. Lung Cancer. 2004;43(2):183.CrossRefPubMedGoogle Scholar
  4. 4.
    Hanna N, Shepherd FA, Fossella FV, Pereira JR, De Marinis F, von Pawel J, et al. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004;22(9):1589–97.CrossRefPubMedGoogle Scholar
  5. 5.
    Sandoro A, Maiorinol Sandoro M. Second-line treatment with vinorelbine in the weekly monotherapy chemotherapy for the treatment of advanced non-small cell lung cancer. Lung Cancer. 1994;11:130. suppl 1, abstr 497.CrossRefGoogle Scholar
  6. 6.
    Murphy WK, Winn RJ, Huber M, et al. Phase II study of taxol in patients with non-small cell lung cancer who have failed platinum containing chemotherapy. Proc Am Soc Clin Oncol. 1994;13:363a. abstr 1224.Google Scholar
  7. 7.
    Rossi A, Perrone F, Barletta R, et al. Activity of gemcitabine in cisplatin-pretreated patients with advanced non-small-cell lung cancer: a phase II trial. Proc Am Soc Clin Oncol. 1999;18:484. abstr 1868.Google Scholar
  8. 8.
    Di Maio M, Chiodini P, Georgoulias V, Hatzidaki D, Takeda K, Wachters FM, et al. Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second-line treatment of advanced non-small-cell lung cancer. J Clin Oncol. 2009;27(11):1836.CrossRefPubMedGoogle Scholar
  9. 9.
    Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, et al. National Cancer Institute of Canada Clinical Trials Group: erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123.CrossRefPubMedGoogle Scholar
  10. 10.
    Stinchcombe TE, Socinski MA. Considerations for second-line therapy of non-small cell lung cancer. Oncologist. 2008;13(1):28–36.CrossRefPubMedGoogle Scholar
  11. 11.
    Tassinari D, Carloni F, Santelmo C, Tamburini E, Lazzari Agli L, Tombesi P, Sartori S. Second line treatments in advanced platinum-resistant non small cell lung cancer. A critical review of literature. 2009 Jan;4(1):27–33Google Scholar
  12. 12.
    Weiss GJ, Langer C, Rosell R, Hanna N, Shepherd F, Einhorn LH, et al. Elderly patients benefit from second-line cytotoxic chemotherapy: a subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer. J Clin Oncol. 2006;24(27):4405.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee DS, Kang JH, Lee CG, Kim SJ, Choi YJ, Lee KY, et al. Predicting survival in patients with advanced non-squamous non-small cell lung cancer: validating the extent of metastasis. Cancer Res Treat. 2013;45(2):95–102.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE, et al. Brain metastasis from non-small cell lung cancer (NSCLC): prognostic importance of the number of involved extracranial organs. Strahlenther Onkol. 2014;190(1):64–7. 2013 Oct 9.CrossRefPubMedGoogle Scholar
  15. 15.
    Florescu M, Hasan B, Seymour L, Ding K, Shepherd FA. National Cancer Institute of Canada Clinical Trials Group. A clinical prognostic index for patients treated with erlotinib in National Cancer Institute of Canada Clinical Trials Group study BR.21. J Thorac Oncol. 2008;3(6):590–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Scagliotti G, Hanna N, Fossella F, Sugarman K, Blatter J, Peterson P, et al. The differential efficacy of pemetrexed according to NSCLC histology: a review of two phase III studies. Oncologist. 2009;14(3):253.CrossRefPubMedGoogle Scholar
  17. 17.
    Nagano T, Kim YH, Goto K, Kubota K, Ohmatsu H, Niho S, et al. Re-challenge chemotherapy for relapsed non-small-cell lung cancer. Lung Cancer. 2010;69(3):315.CrossRefPubMedGoogle Scholar
  18. 18.
    Bonomi P, Langer C, O’Brien M, et al. Analysis of prognostic factors in patients with advanced relapsed/refractory NSCLC: Cox regression analysis of a randomized phase III trial comparing docetaxel and paclitaxel poliglumex (PPX). J Clin Oncol. 2006;24(18):374s.Google Scholar
  19. 19.
    Pujol JL, Paul S, Chouaki N, Peterson P, Moore P, Berry DA, et al. Survival without common toxicity criteria grade 3/4 toxicity for pemetrexed compared with docetaxel in previously treated patients with advanced non-small cell lung cancer (NSCLC): a risk-benefit analysis. J Thorac Oncol. 2007;2(5):397.CrossRefPubMedGoogle Scholar
  20. 20.
    Wen PY, Black PM, Loeffler JS. Metastatic brain cancer. In: de Vita V, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 2655–70.Google Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Hatice Odabas
    • 1
  • Arife Ulas
    • 2
  • Kubra Aydin
    • 1
  • Mevlude Inanc
    • 3
  • Asude Aksoy
    • 4
  • Dogan Yazilitas
    • 5
  • Mehmet Turkeli
    • 6
  • Sinemis Yuksel
    • 1
  • Ali Inal
    • 7
  • Ahmet S. Ekinci
    • 2
  • Alper Sevinc
    • 8
  • Nebi S. Demirci
    • 9
  • Mukremin Uysal
    • 10
  • Necati Alkis
    • 2
  • Faysal Dane
    • 11
  • Mehmet Aliustaoglu
    • 1
  • Mahmut Gumus
    • 12
  1. 1.Department of Medical OncologyKartal Dr. Lutfi Kirdar Education and Research HospitalIstanbulTurkey
  2. 2.Department of Medical OncologyAbdurrahman Yurtaslan Oncology HospitalAnkaraTurkey
  3. 3.Department of Medical OncologyErciyes University Faculty of MedicineKayseriTurkey
  4. 4.Department of Medical OncologyInonu University Faculty of MedicineMalatyaTurkey
  5. 5.Department of Medical OncologyKonya Education and Research HospitalKonyaTurkey
  6. 6.Department of Medical OncologyAtaturk University Faculty of MedicineErzurumTurkey
  7. 7.Department of Medical OncologyDicle University Faculty of MedicineDiyarbakirTurkey
  8. 8.Department of Medical OncologyGaziantep University Faculty of MedicineGaziantepTurkey
  9. 9.Department of Medical OncologyAnkara Numune Education and Research HospitalAnkaraTurkey
  10. 10.Department of Medical OncologyKocatepe University Faculty of MedicineAfyonTurkey
  11. 11.Department of Medical OncologyMarmara University Faculty of MedicineIstanbulTurkey
  12. 12.Department of Medical OncologyBezmialem Vakif University School of MedicineIstanbulTurkey

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