Response to cytostatic treatment in inoperable adenocarcinoma of the lung: critical implications

Abstract

Summary The prognostic factors for response to chemotherapy and the prognostic impact of response status on survival, relative to other prognostic variables, were evaluated among 53 responding (9 complete responses; 44 partial responses) and 165 non-responding patients with inoperable adenocarcinoma of the lung (ACL). Multiple logistic regression analysis, including 27 pretreatment variables, revealed that the only significant predictor of response was bidimensionally measurable disease parameter (P=0.02), followed by brain metastases that were negatively correlated to response, although insignificantly (P=0.10). Univariate landmark analyses among patients alive at 8, 12, 16 and 24 weeks showed a trend towards better survival for responders compared with non-responders, but did not reach a significant level at any time (P values 0.78, 0.57, 0.23 and 0.12, respectively). Death hazard ratios for responders to non-responders were 0.91, 0.89, 0.79 and 0.73. Muftivariate regression analysis among patients alive at 16 weeks demonstrated a significant impact on survival for performance status, non-radical tumour resection, liver metastases and LDH, while the impact of response status in comparison was weak and insignificant. This reflects the unsatisfactory treatment results achieved in inoperable ACL, with the majority of responses being partial, and calls for improvement of the cytostatic treatment currently available.

Characterization of a Real-World Response Variable and Comparison with RECIST-Based Response Rates from Clinical Trials in Advanced NSCLC

“…By abstracting response from the clinician's notes and assessments, our approach likely provides a more holistic synthesis of patients' clinical status than approaches leveraging radiology images or radiology reports alone [7,29,31]. Using this real-world variable, achieving responder/non-responder status appeared to be associated with downstream rwOS to an extent comparable to the associations reported between RECIST-based response and OS in NSCLC clinical trials [32][33][34][35][36]. Our CI confidence interval, HR hazard ratio, rwOS real-world overall survival, rwPFS real-world progression-free survival, rwR real-world response a Adjusted for age at advanced diagnosis, smoking status, histology, and stage at initial diagnosis Weighted rwRR refers to the analyses performed on the real-world cohorts after inverse odds weights (based on published summary baseline characteristics of the trial populations) were applied in order to maximize the relevance of these cohorts to the intended comparison.…”

Metastatic Pattern in Non-resectable Non-small Cell Lung Cancer

“…Surgery is the treatment of choice, but almost 75% of the patients present with non-resectable disease (1). In most cases, the treatment options therefore include chemotherapy and/or radiotherapy (2,3). Systemic treatment is associated with a statistically significant, though modest, improvement in survival (4).…”

The cigarette burden (measured by the number of pack-years smoked) negatively impacts the response rate to platinum-based chemotherapy in lung cancer patients

“…The pretreatment variables on the survival are not necessarily identical to the predicting response to CT [22,23]. Therefore, the identification of these factors would also be useful in analysis of the response rate to CT in LC patients.…”