University of Rochester, Rochester, NY, United States of America.
Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic, Rochester, MN, United States of America.
J Geriatr Oncol. 2021 May;12(4):563-571. doi: 10.1016/j.jgo.2020.09.005. Epub 2020 Sep 16.
Optimal treatment for older adults with stage III non-small cell lung cancer (NSCLC) remains unclear. Here we hypothesized that sequential chemoradiation therapy (sCRT) is better tolerated than concurrent (cCRT) but confers acceptable efficacy. We evaluated these strategies in older adults utilizing Alliance for Clinical Trials in Oncology data.
Pooled analyses from 6 first-line stage III NSCLC CRT trials (Cancer and Leukemia Group B 8433, 8831, 9130, 30106, 30407, 39801) were used to compare toxicity and survival outcomes with cCRT versus sCRT in patients age ≥ 65 years. Grade 3-5 adverse events (AEs), progression-free and overall survival (PFS; OS) are reported with adjustment for covariates.
Four hundred older adults, of whom 106 (26.5%) had received sCRT and 294 (73.5%) had received cCRT, comprised the cohorts. Virtually all had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 (99%). More grade 3-5 AEs were observed at any time-point with cCRT than sCRT (94.2% versus 86.8%; 95% confidence interval for difference in proportions, 1.3%, 15.5%) and this finding remained after adjusting for length of study treatment (P = 0.018). Comparable PFS and OS were observed with sCRT versus cCRT (median: 8.0 versus 9.2 months; median: 11.9 versus 13.4 months, respectively) even after adjustment for age, sex, ECOG PS, body mass index, pretreatment weight loss, stage, and cisplatin-based therapy (P = 0.604 and P = 0.906, respectively).
These data show that sCRT was associated with less toxicity than cCRT with no associated statistically significant decrease in efficacy outcomes and that sCRT merits further study in this population.
对于 III 期非小细胞肺癌（NSCLC）的老年患者，最佳治疗方法仍不明确。本研究假设序贯放化疗（sCRT）的耐受性优于同期放化疗（cCRT），同时具有可接受的疗效。我们利用肿瘤临床协作联盟的数据，评估了这两种策略在老年患者中的应用。
对 6 项 III 期 NSCLC 放化疗一线治疗的临床试验（癌症与白血病组 B8433、8831、9130、30106、30407 和 39801）的数据进行汇总分析，比较了年龄≥65 岁的患者接受 cCRT 与 sCRT 的毒性和生存结局。报告了 3-5 级不良事件（AE）、无进展生存期（PFS）和总生存期（OS），并对协变量进行了调整。
400 名老年患者纳入本研究，其中 106 名（26.5%）接受 sCRT，294 名（73.5%）接受 cCRT。几乎所有患者的东部肿瘤协作组体能状态（ECOG PS）均为 0-1 分（99%）。cCRT 在任何时间点的 3-5 级 AE 发生率均高于 sCRT（94.2%比 86.8%；差异的 95%置信区间为 1.3%至 15.5%），且在调整研究治疗时间后仍有此发现（P=0.018）。sCRT 与 cCRT 的 PFS 和 OS 相当（中位值：8.0 个月与 9.2 个月；中位值：11.9 个月与 13.4 个月），即使在调整年龄、性别、ECOG PS、体质指数、治疗前体重减轻、分期和含顺铂的治疗后，差异仍无统计学意义（P=0.604 和 P=0.906）。
这些数据表明，sCRT 与 cCRT 相比，毒性更小，但疗效结局无显著统计学差异，sCRT 在该人群中值得进一步研究。
