Factors of interrupting chemotherapy in patients with Advanced Non-Small-Cell Lung Cancer

Rhizlane Belbaraka, Olivier Trédan, Isabelle Ray-Coquard, Giselle Chvetzoff, Agathe Bajard, David Pérol, Nabil Ismaili, Mohammed Ismaili, Hassan Errihani, Thomas Bachelot, Paul Rebattu, Rhizlane Belbaraka, Olivier Trédan, Isabelle Ray-Coquard, Giselle Chvetzoff, Agathe Bajard, David Pérol, Nabil Ismaili, Mohammed Ismaili, Hassan Errihani, Thomas Bachelot, Paul Rebattu

Abstract

Background: Little is known about prognosis of metastatic patients after receiving a first-line treatment and failure. Our group already showed in pre-treated patients enrolled in phase I clinical trials that a performance status (PS) > 2 and an LDH > 600 UI/L were independent prognostic factors. In this prospective study, which included 45 patients, we identified clinical and biological variables as outcome predictors in metastatic Non-Small Cell lung cancer after first line chemotherapy were identified.

Findings: Forty-five patients that were previously treated for metastatic disease from 12/2000 to 11/2005 in the comprehensive cancer centre (Centre Léon Bérard). Clinical assessment and blood parameters were recorded and considered. Patient prognostic factors for overall survival (OS) with a 0.05-significance level in univariate analysis were entered in a multivariate Cox model for further analysis.Patients' median age was 58.5 years (range: 37 - 76). Sixty two percent of the patients were PS = 0 or 1. After inclusion, nine patients received second-line (22.5%), and two received third-line chemotherapy (5%). Univariate analysis showed that the factors associated with reduced OS were: PS > 2, weight loss >10%, more than one line of chemotherapy treatment and abnormal blood parameters (hemoglobin (Hb), platelet and neutrophils counts). Multiple regression analysis confirmed that PS > 2 and abnormal hemoglobin were independent predictors for low overall survival. According to the presence of none (33%), 1 (37%) and 2 (30%) prognostic factors, median OS were 12, 5 and 2 months respectively.

Conclusion: From this prospective study, both PS and anemia were found as independent determinants of survival, we found that both PS and anemia were independent determinants of survival. The combination of poor PS and anemia is an effective strategy to predict survival in the case of patients with metastatic NSCLC receiving further treatment after the first line.

Figures

Figure 1
Figure 1
Relationship between performance status and overall survival
Figure 2
Figure 2
Relationship between hemoglobin level and overall survival
Figure 3
Figure 3
Results of analysis of 0, 1 or 2 prognostic factors with Kaplan-Meier overall survival analysis

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