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Platinum-Based Chemotherapy in Older Patients with Non-Small Cell Lung Cancer: What to Expect in the Real World

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Abstract

Background

The role of platinum-based chemotherapy (PBC) for the treatment of older patients with non-small cell lung cancer (NSCLC) is still a matter of debate, despite the advent of immunotherapy.

Objective

The aim of the study was to identify factors associated with first-line PBC prescription and, secondly, to evaluate the impact of first-line PBC on survival, treatment intensity, risk of hospitalization, and subsequent treatments.

Patients and Methods

We reviewed a consecutive series of 474 older patients (age ≥ 70 years) diagnosed with stage IIIB–IV NSCLC at the Department of Oncology, University Hospital of Udine, Italy from January 2009 to March 2017.

Results

Overall, 198 patients were deemed eligible, and 65.2% received a PBC. At multivariate analysis, older age was the only factor associated with PBC prescription. In the whole cohort, 46 patients (23.2%) were hospitalized for chemotherapy-related toxicity. Both PBC prescription (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.02–4.87, p = 0.04) and tumor burden (OR 2.39, 95% CI 1.07–5.32, p = 0.03) emerged as independent risk factors for hospitalization. Moving to significant predictors of patterns of care, Eastern Cooperative Oncology Group (ECOG) performance status > 0 was associated with greater risk of first-line failure (OR 2.20, 95% CI 1.15–4.20, p = 0.02), while bone metastases (OR 0.29, 95% CI 0.12–0.69, p = 0.005) and a Charlson Comorbidity Index score ≥ 3 (OR 0.40, 95% CI 0.19–0.84, p = 0.016) independently predicted lower probability of receiving second-line therapy. Remarkably, PBC did not significantly impact overall survival (hazard ratio [HR] 0.83, 95% CI 0.61–1.14, p = 0.24) and progression-free survival (HR 0.95, 95% CI 0.70–1.28, p = 0.73) compared to single-agent chemotherapy (SAC). However, according to an exploratory landmark analysis, patients who received four cycles of treatment or maintenance therapy experienced prolonged overall survival, regardless of PBC use.

Conclusions

This study evaluated the real-world use of PBC in older patients with NSCLC, offering an insight into the determinants of its prescription and the pattern of care of these patients. Of note, PBC use was associated with a higher likelihood of hospitalization for chemotherapy-related toxicity, with no benefit on survival compared to SAC.

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Availability of Data and Material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medicine (DAME), University of Udine, 33100, Udine, Italy

    Giacomo Pelizzari, Francesco Cortiula, Marco Giavarra, Michele Bartoletti, Camilla Lisanti, Vanessa Buoro, Monica Cattaneo & Fabio Puglisi

  2. Department of Oncology, Santa Maria Della Misericordia Hospital (ASUFC), 33100, Udine, Italy

    Giacomo Pelizzari, Francesco Cortiula, Marco Giavarra, Michele Bartoletti, Camilla Lisanti, Vanessa Buoro, Monica Cattaneo, Ciro Rossetto, Simona Rizzato, Marianna Macerelli, Gianpiero Fasola & Alessandro Follador

  3. Dipartimento Di Oncologia Medica, Oncologia Medica E Prevenzione Oncologica, Centro Di Riferimento Oncologico Di Aviano (CRO), IRCCS, 33081, Aviano, Italy

    Fabio Puglisi

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  1. Giacomo Pelizzari
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Contributions

GP contributed to the concept and design of the study, acquisition of data, statistical analysis, and interpretation of data. Furthermore, he contributed to the drafting and revision of the article and the final approval of the version to be published. FC, MG, MC, and CL contributed to the acquisition of data and drafting of the article. MB and VB contributed to the drafting of the article. CR, SR, FP, and MM contributed to the revision of the article. GF and AF contributed to the concept and design of the study, interpretation of data, revision of the article, and the final approval of the version to be published. All authors have seen and approved the final manuscript.

Corresponding author

Correspondence to Giacomo Pelizzari.

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Funding

No external funding was used in the preparation of this article.

Conflict of interest

AF declares honoraria for advisory boards from Astrazeneca and MSD, and reports travel expenses from Roche, MSD, and Eisai. FP declares honoraria for advisory boards, activities as a speaker, and travel expenses from Amgen, Astrazeneca, Celgene, Eisai, Eli Lilly, Ipsen, MSD, Novartis, Pierre-Fabre, Pfizer, Roche, and Takeda, and reports research funding from Astrazeneca, Roche, and Eisai. GP, FC, MG, MB, CL, VB, MC, CR, SR, MM, and GF declare that they have no conflicts of interest that might be relevant to the contents of this article.

Ethics approval

The study was approved by the Internal Review Board of the Department of Oncology, University Hospital of Udine, and by the regional ethics committee (N° Protocol 22,651, ratified in September 2017).

Consent to participate

Informed consent was obtained for the use of clinical data, rendered anonymous, for purposes of clinical research, epidemiology, training, and study of diseases.

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Pelizzari, G., Cortiula, F., Giavarra, M. et al. Platinum-Based Chemotherapy in Older Patients with Non-Small Cell Lung Cancer: What to Expect in the Real World. Drugs Aging 37, 677–689 (2020). https://doi.org/10.1007/s40266-020-00785-8

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