A Population-Based Comparative Effectiveness Study of Chemoradiation Regimens and Sequences in Stage III NSCLC
Researchers sought to compare the potential benefits of consolidation chemotherapy vs concurrent-alone chemotherapy (ie, chemoradiotherapy) in older patients (≥ 65 years) diagnosed with stage III NSCLC between 2002 and 2009.
A total of 1,688 patients treated with concurrent-alone or concurrent-consolidation regimens were identified; median follow-up was 29 months. Choice of chemotherapy agents (ie, five commonly used platinum-based doublets) did not correlate with outcome.
For concurrent-consolidation vs concurrent-alone regimens, the median overall survival was 21 months vs 18 months, respectively, and the median cancer-specific survival was 23 months vs 19 months, respectively. On multivariate analysis, concurrent-consolidation chemotherapy remained associated with improved overall survival (hazard ratio [HR] = 0.85, P = .04), and there was a trend toward improved cancer-specific survival (HR = 0.87, P = .12). Importantly, the benefit of concurrent-consolidation chemotherapy held only for patients treated with carboplatin-taxane but not with cisplatin-etoposide.
Survival outcomes were similar, regardless of which commonly used platinum-based doublet was used. Patients who received cisplatin during radiation therapy did not appear to benefit from additional chemotherapy. However, for patients receiving carboplatin, consolidation chemotherapy was associated with improved overall and cancer-specific survival rates.