Survival of Patients with Advanced Non-Small Cell Lung Cancer Enrolled in Clinical Trials

Abstract

Background: Up-to-date oncological therapy has been accomplished through the results of clinical trials (CTs). We analyzed the overall survival (OS) of patients with non-small cell lung cancer (NSCLC) and its relation to CT enrollment. Methods: The study included 1,042 patients with advanced NSCLC treated at the Instituto Nacional de Cancerología. All patients received treatment according to the national and international guidelines. Data were collected from medical records. Patients were subgrouped on the basis of their CT enrollment as follows: participants in any CT (ACT), exclusively intervention CTs (ICT) or exclusively pharmaceutical-sponsored CTs (PCT). Results: The CT enrollment effect was assessed through a multivariate Cox proportional hazards model. Thirty percent of the patients were in ACT, 28.3% in ICT and 13.7% in PCT. Female gender (p = 0.001), adenocarcinoma histology (p = 0.018), positive EGFR mutation (p = 0.006), and better ECOG performance status (<2) (p ≤ 0.0001) were more frequent in patients enrolled in CT; further, tobacco smoking (p ≤ 0.0001) and KRAS mutation (p = 0.001) were more frequent in patients who were not enrolled in a CT. Conclusion: Enrollment in ACT was associated with a better OS (hazard ratio: 0.47-0.74). NSCLC patients enrolled in a CT have an improved survival in an independent manner to other prognostic factors.

Clinical Trial Accrual at Initial Course of Therapy for Cancer and Its Impact on Survival

“…Treatment at low-accruing centers was associated with increased risk of death of 91% (HR, 1.91; 95% CI, 1.37-2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23-2.40) after RT compliance adjustment. Similarly, Arrieta et al 14 reported a retrospective review of 1,042 patients with NSCLC in Mexico treated from 2007 through 2014 and concluded that enrollment in a clinical trial was associated with better OS (HR, 0.47-0.74), independent of other confounders.…”

“…Although a previous systematic review concluded that enrollment in clinical trials was not associated with a survival benefit, 5 it did not account for potential confounders, including socioeconomic status, age, race, comorbidity, or treatment year. Since that review, modern studies have been published showing a survival benefit for patients enrolled in trials, [13][14][15] after adjusting for confounders. Similarly, we found a benefit for survival among patients enrolled in a trial.…”

Oridonin enhances the radiosensitivity of lung cancer cells by upregulating Bax and downregulating Bcl‑2

“…Adenocarcinoma, squamous cell carcinoma and large cell carcinoma are the three common types of NSCLC (2,3). In patients with lung cancer, 85-90% of cases are diagnosed as NSCLC (4). Compared with small cell carcinoma, the growth of NSCLC is slower (2).…”

“…Compared with small cell carcinoma, the growth of NSCLC is slower (2). The clinical symptoms of NSCLC include fever, chest pain, shortness of breath, coughing and bloody sputum (4,5). Clinically, NSCLC is typically treated with surgery, chemotherapy, radiotherapy, immunotherapy and combination therapy (6).…”

Survival and Participation in a Cancer Clinical Trial: A Provocative Relationship

“…In this issue of Oncology , Arrieta et al [3] provide a retrospective review of 1,042 non-small cell lung cancer patients in Mexico treated from January 2007 to December 2014 who were or were not enrolled in a clinical trial. In this interesting and well-documented analysis, enrollment in a clinical trial was associated with superior overall survival.…”