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Support Care Cancer. 2019 Jun 7. doi: 10.1007/s00520-019-04875-1. [Epub ahead of print]

Relative dose intensity of first-line chemotherapy and overall survival in patients with advanced non-small-cell lung cancer.

Author information

1
Duke University Medical Center, Trent Drive, Duke South, 25177 Morris Building, Durham, NC, 27710, USA. jeffrey.a.crawford@duke.edu.
2
Virginia Cancer Specialists, US Oncology Network, Arlington, VA, USA.
3
McKesson Specialty Health, The Woodlands, TX, USA.
4
Amgen Inc., Thousand Oaks, CA, USA.
5
Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA.

Abstract

PURPOSE:

The effects of chemotherapy dose intensity on survival in patients with advanced non-small-cell lung cancer (NSCLC) are poorly understood. We retrospectively analyzed dose delays/reduction, relative dose intensity (RDI), and the association between chemotherapy intensity and survival in advanced NSCLC.

METHODS:

This retrospective cohort study included adults with advanced lung cancer who received first-line myelosuppressive platinum-based chemotherapy (January 2007-December 2010) in ~ 230 US Oncology Network community practices. Dose delays ≥ 7 days, dose reductions ≥ 15%, and RDI relative to standard regimens were described. Overall survival (OS) was measured using Kaplan-Meier and Cox proportional hazard (PH) models.

RESULTS:

Among 3866 patients with advanced NSCLC, 32.4% experienced dose delays ≥ 7 days, 50.1% experienced dose reductions ≥ 15%, and 40.4% had RDI < 85%. Reduced RDI was also common regardless of baseline ECOG PS (ECOG PS ≥ 2, 56.2%; ECOG PS 0, 33.6%) and tumor subgroup (squamous cell carcinoma, 52.2%; adenocarcinoma, 36.0%). When stratified by chemotherapy intensity measures, significant OS differences were observed only for dose delays. Median (95% CI) OS was 1.02 years (0.96-1.12) for dose delays ≥ 7 days and 0.71 years (0.66-0.77) for dose delays < 7 days. In multivariable Cox PH analysis, dose delays ≥ 7 days (HR = 0.71; 95% CI = 0.63-0.80) and RDI ≥ 85% (HR = 1.18; 95% CI = 1.05-1.32) were significantly associated with decreased mortality.

CONCLUSIONS:

Dose delays, dose reductions, and reduced RDI were common, and dose delays ≥ 7 days and high RDI were significantly associated with decreased mortality. These results can help identify potential risk factors and characterize the effect of chemotherapy dose modification strategies on mortality.

KEYWORDS:

Chemotherapy; Community health services; Lung cancer; Retrospective studies

PMID:
31172284
DOI:
10.1007/s00520-019-04875-1

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