Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
Curr Probl Cancer. 2022 Aug;46(4):100867. doi: 10.1016/j.currproblcancer.2022.100867. Epub 2022 May 21.
Veterans with locoregional non-small cell lung cancer (NSCLC) may benefit from adjuvant chemotherapy. However, comorbidities and other factors may impact the harms and benefits of this treatment. Here, we identified the optimal indications for adjuvant chemotherapy in Veterans with NSCLC, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and/or coronary artery disease (CAD). We used data from randomized controlled trials (RCTs) and Veterans Administration (VA) databases to enhance a simulation model. Then, we conducted in-silico RCTs comparing adjuvant chemotherapy vs observation among Veterans with stage II-IIIA NSCLC. Among Veterans without COPD or CKD, adjuvant chemotherapy was the optimal strategy regardless of the presence or absence of CAD except for patients >70 years with squamous cell carcinoma. Conversely, most veterans without COPD but with CKD were optimally managed with observation. Veterans with COPD but without CKD, benefited from adjuvant chemotherapy if they were ≤70 years with stage II-IIIA adenocarcinoma or <60 years with stage II-IIIA squamous cell carcinoma. Adjuvant chemotherapy was only beneficial for Veterans with both COPD and CKD among stage II-IIIA adenocarcinoma <60 years of age. Veterans with stages II-IIIA squamous cell carcinoma, COPD, and CKD were optimally managed with observation. Many Veterans with comorbidities are optimally managed with observation post-surgical resection. However, we also identified several groups of Veterans whom the benefits of adjuvant chemotherapy outweighed the risks of early toxicity. Our findings could inform patient-provider discussions and potentially reduce physicians' uncertainty about the role of adjuvant chemotherapy in this population.
患有局部区域非小细胞肺癌（NSCLC）的退伍军人可能受益于辅助化疗。然而，合并症和其他因素可能会影响这种治疗的危害和益处。在这里，我们确定了患有 NSCLC、慢性阻塞性肺疾病（COPD）、慢性肾脏病（CKD）和/或冠状动脉疾病（CAD）的退伍军人接受辅助化疗的最佳适应证。我们使用随机对照试验（RCT）和退伍军人管理局（VA）数据库的数据来增强模拟模型。然后，我们进行了计算机模拟 RCT，比较了患有 II 期-IIIA 期 NSCLC 的退伍军人接受辅助化疗与观察的情况。在没有 COPD 或 CKD 的退伍军人中，无论是否存在 CAD，辅助化疗都是最佳策略，除了 70 岁以上的鳞状细胞癌患者。相反，大多数没有 COPD 但有 CKD 的退伍军人最好接受观察治疗。如果患有 II 期-IIIA 期腺癌的 COPD 退伍军人≤70 岁或患有 II 期-IIIA 期鳞状细胞癌的<60 岁，则受益于辅助化疗。只有在 60 岁以下的 II 期-IIIA 期腺癌且同时患有 COPD 和 CKD 的退伍军人中，辅助化疗才有益。患有 II 期-IIIA 期鳞状细胞癌、COPD 和 CKD 的退伍军人最好接受观察治疗。许多患有合并症的退伍军人在手术后最好接受观察治疗。然而，我们还确定了几组退伍军人，他们接受辅助化疗的益处大于早期毒性的风险。我们的研究结果可以为患者-提供者的讨论提供信息，并有可能减少医生对辅助化疗在这一人群中作用的不确定性。
