Trends, predictors, and impact of systemic chemotherapy in small cell lung cancer patients between 1985 and 2005

Abstract

Background The last three decades have witnessed limited therapeutic advances in SCLC management. We evaluated real-world trends in use of systemic therapies and the impact on patient outcome in US. Methods We employed SEER-MEDICARE for SCLC patients diagnosed between 1985 and 2005. The 1985-1990 period served as baseline for temporal analysis conducted at 5-year intervals (1985-1990, 1991-1995, 1996-2000, 2001-2005). Cox proportional models were employed to estimate the effect of chemotherapy on survival. Results were validated using propensity-matched analysis. Results There were 47,351 eligible patients; male (52%); median age: 71 years; Whites-87%; Blacks-7%; Asians-1.4%. The proportion of patients treated with chemotherapy was low but increased over time (38, 55, 50, 53%; p<0.001). Race, diagnosis period, age, stage and location of residence significantly predicted chemotherapy use. Females (51%), Asians (53%) and rural residents (60%) were more likely to receive chemotherapy. The median overall survival with and without chemotherapy was 9.6 and 3.6 months. Linear trend analyses showed modest reduction in the impact of chemotherapy on survival in patients treated with chemotherapy over untreated patients (HRs: 0.59, 0.61, 0.64, 0.62; p<0.001) but an overall trend of improved survival within treated (HRs: 1.0, 1.03, 1.00, 0.96; p=0.005) and untreated (HRs: 0.99, 0.94, 0.92; p<0.001) patients. There was no survival difference between patients treated with carboplatin versus cisplatin (HR: 0.99 CI: 0.81-1.19; p=0.875). Additional therapy beyond platinum-based chemotherapy was associated with survival benefit (HR: 0.78 CI: 0.75-0.81; p<0.001). Conclusions Chemotherapy use was associated with survival benefit in MEDICARE SCLC patients treated in the real-world setting.

Clinical outcomes of surgically resected combined small cell lung cancer: a two-institutional experience

“…Currently, the standard CTx regimen for SCLC is etoposide and cisplatin (EP), while histologically-mixed tumors with both SCLC and NSCLC components may fail EP protocols since there is less sensitivity of the NSCLC component to this regimen. The present study showed that adjuvant therapy after resection could improve the prognosis, consistent with previous studies (22)(23)(24). In a study by Luo and colleagues (25), the efficacy and safety of NIP with EP in the treatment of advanced c-SCLCs were compared, which demonstrated that an EP regimen presented a survival benefit, although the difference was not statistically significant.…”

Treatment and outcome of 432 patients with extensive-stage small cell lung cancer in first, second and third line – Results from the prospective German TLK cohort study

“…Several studies have suggested that combination regimen with either cisplatin or carboplatin are comparable regarding ORR, PFS, and OS in first-line therapy: A meta-analysis of four randomised trials concluded that both regimens were equally effective (median OS 9.6 months for cisplatin and 9.4 months for carboplatin, with an overall response rate of 67% and 66%, respectively) and differed only in their toxicity profiles [15]. Similarly, studies at population-level found no significant difference in survival between combinations based on carboplatin or cisplatin [17,18]. Karam and colleagues reported a median OS of 11 months for carboplatin plus etoposide and 10 months for cisplatin plus etoposide for patients with extensive-stage SCLC in British Columbia from 2004 to 2008 [17].…”

The clinical conundrum of managing relapsed small cell lung cancer

“…Temozolomide offers the additional advantages of oral dosing and demonstrable central nervous system activity . An analysis of real‐world Surveillance, Epidemiology, and End Results–Medicare data showed significant utilization of the single‐agent chemotherapy approach and showed that these agents are associated with improved OS in comparison with no treatment . In the absence of comparative data, the choice of any of these agents is based on the patient's overall clinical profile and convenience.…”