|Title||Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non-Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies.|
|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Stinchcombe, Thomas E., Ying Zhang, Everett E. Vokes, Joan H. Schiller, Jeffrey D. Bradley, Karen Kelly, Walter J. Curran, Steven E. Schild, Benjamin Movsas, Gerald Clamon, Ramaswamy Govindan, George R. Blumenschein, Mark A. Socinski, Neal E. Ready, Wallace L. Akerley, Harvey J. Cohen, Herbert H. Pang, and Xiaofei Wang|
|Journal||J Clin Oncol|
|Date Published||2017 Sep 01|
|Keywords||Age Factors, Aged, Carcinoma, Non-Small-Cell Lung, Chemoradiotherapy, Clinical Trials, Phase II as Topic, Clinical Trials, Phase III as Topic, Female, Humans, Lung Neoplasms, Male, Neoplasm Staging, Randomized Controlled Trials as Topic|
Purpose Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P < .01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.
|Alternate Journal||J Clin Oncol|
|Original Publication||Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US National Cancer Institute Cooperative Group Studies.|
|PubMed Central ID||PMC5578390|
|Grant List||P01 CA142538 / CA / NCI NIH HHS / United States |
R21 AG042894 / AG / NIA NIH HHS / United States
U10 CA180833 / CA / NCI NIH HHS / United States
U10 CA180888 / CA / NCI NIH HHS / United States
Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non-Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies.