Tabchi S, Kassouf E, Florescu M, Tehfe M, Blais N
Hematology-Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, QC.
Curr Oncol. 2017 Apr;24(2):e115-e122. doi: 10.3747/co.24.3355. Epub 2017 Apr 27.
Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions.
We retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined.
During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; < 0.001).
Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer.
尽管有众多突破性疗法，但无法手术的肺癌仍给那些可能不适合化疗的患者带来沉重负担。为了确定新兴的基于免疫疗法的治疗模式的潜在候选者，我们探索了影响治疗决策的临床和生物学因素。
我们回顾性分析了2011年1月1日至2013年12月31日期间在我校附属癌症中心确诊的患者记录。检查了患者的人口统计学特征、全身治疗情况和生存率。
在3年的研究期间，共确定了683例符合纳入标准的患者。49.5%的患者接受了一线治疗；只有22.4%的患者接受了进一步的治疗。不进行治疗的主要原因是体能状态差[PS（43.2%）]、体能状态迅速恶化（31.9%）、患者拒绝治疗（20.9%）以及合并症（4%）。年龄较大、诊断时存在脑转移以及非小细胞组织学类型也与治疗受限有关。未接受治疗的患者中肿瘤学转诊很少见（32.2%）。接受治疗的老年患者和体能状态差的患者生存率更高（风险比：0.25；95%置信区间：0.16至0.38；以及风险比：0.44；95%置信区间：0.23至0.87；P<0.001）。
晚期肺癌仍然是一个治疗挑战，很大比例的患者被认为不适合治疗。在采取适当措施确保老年患者和体能状态相对较差的患者纳入大型临床试验之前，这个问题无法解决。鉴于免疫疗法似乎更具耐受性，在这种情况下可能会很有意义。另一项重要工作是部署策略，以减少对高度怀疑肺癌患者诊断过程中的等待时间。
