Division of Hematology-Oncology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea,
Department of Internal Medicine, Keimyung University Graduate School of Medicine, Daegu, Republic of Korea.
Oncology. 2022;100(6):313-319. doi: 10.1159/000524476. Epub 2022 Apr 7.
Elderly patients with extensive-disease small-cell lung cancer (ED-SCLC) have a high risk of chemotherapy toxicity due to multiple comorbidities and poor performance status. Although dose modification is often used to avoid toxicity in elderly patients with ED-SCLC, there is little data on the effect of initial dose-reduced chemotherapy on survival outcomes.
We retrospectively reviewed 100 elderly patients (≥70 years) with ED-SCLC who received first-line etoposide plus platinum chemotherapy between January 2006 and December 2020.
The median age was 74 years. Eighty-nine patients (89%) had a history of smoking, and 38 (38%) had chronic lung disease. Thirty-four patients (34%) received dose-reduced etoposide plus platinum in the first cycle. The dose-reduced group had significantly higher age, lower body mass index, and poor Eastern Cooperative Oncology Group Performance Score. There were no significant differences in survival outcomes between the dose-reduced and full-dose chemotherapy (median overall survival [OS], 4.9 vs. 6.5 months, p = 0.440; median progression-free survival [PFS], 3.7 vs. 4.6 months, p = 0.272). In multivariate analyses, DR in the first cycle (hazard ratio 0.519, 95% CI: 0.269-1.000, p = 0.050) was significantly associated with OS. Following a subgroup analysis of 59 patients who received minimum four cycles, no significant differences in survival outcomes between the two groups (median OS, 10.9 vs. 9.4 months, p = 0.817; median PFS, 6.3 vs. 6.5 months, p = 0.902) were noted.
The dose-reduced chemotherapy with first-line etoposide plus platinum had non-inferior survival outcomes compared to the full-dose chemotherapy in elderly patients with ED-SCLC.
由于多种合并症和较差的体能状态，广泛期小细胞肺癌（ED-SCLC）的老年患者化疗毒性风险较高。尽管在老年 ED-SCLC 患者中经常使用剂量调整来避免毒性，但关于初始剂量降低的化疗对生存结果的影响的数据很少。
我们回顾性分析了 2006 年 1 月至 2020 年 12 月期间接受一线依托泊苷加铂类化疗的 100 例年龄≥70 岁的 ED-SCLC 老年患者。
中位年龄为 74 岁。89 例（89%）有吸烟史，38 例（38%）有慢性肺部疾病。34 例（34%）患者在第一周期接受了剂量降低的依托泊苷加铂类药物治疗。剂量降低组的年龄、体重指数和东部合作肿瘤学组体能状态评分明显较低。在生存结果方面，剂量降低组与全剂量化疗组之间无显著差异（中位总生存期[OS]，4.9 与 6.5 个月，p=0.440；中位无进展生存期[PFS]，3.7 与 4.6 个月，p=0.272）。在多变量分析中，第一周期的 DR（风险比 0.519，95%CI：0.269-1.000，p=0.050）与 OS 显著相关。对接受至少 4 个周期治疗的 59 例患者进行亚组分析后，两组之间的生存结果无显著差异（中位 OS，10.9 与 9.4 个月，p=0.817；中位 PFS，6.3 与 6.5 个月，p=0.902）。
与全剂量化疗相比，一线依托泊苷加铂类药物的剂量降低化疗在老年 ED-SCLC 患者中的生存结果无差异。
