Palliative chemotherapy beyond three courses conveys no survival or consistent quality-of-life benefits in advanced non-small-cell lung cancer
Open Access
- 3 October 2006
- journal article
- research article
- Published by Springer Nature in British Journal of Cancer
- Vol. 95 (8) , 966-973
- https://doi.org/10.1038/sj.bjc.6603383
Abstract
This randomised multicentre trial was conducted to establish the optimal duration of palliative chemotherapy in advanced non-small-cell lung cancer (NSCLC). We compared a policy of three vs six courses of new-generation platinum-based combination chemotherapy with regard to effects on quality of life (QoL) and survival. Patients with stage IIIB or IV NSCLC and WHO performance status (PS) 0–2 were randomised to receive three (C3) or six (C6) courses of carboplatin (area under the curve (AUC) 4, Chatelut's formula, equivalent to Calvert's AUC 5) on day 1 and vinorelbine 25 mg m−2 on days 1 and 8 of a 3-week cycle. Key end points were QoL at 18 weeks, measured with EORTC Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13, and overall survival. Secondary end points were progression-free survival and need of palliative radiotherapy. Two hundred and ninety-seven patients were randomised (C3 150, C6 147). Their median age was 65 years, 30% had PS 2 and 76% stage IV disease. Seventy-eight and 54% of C3 and C6 patients, respectively, completed all scheduled chemotherapy courses. Compliance with QoL questionnaires was 88%. There were no significant group differences in global QoL, pain or fatigue up to 26 weeks. The dyspnoea palliation rate was lower in the C3 arm at 18 and 26 weeks (Pvs 32 weeks in the C6 group (P=0.75, HR 1.04, 95% CI 0.82–1.31). One- and 2-year survival rates were 25 and 9% vs 25 and 5% in the C3 and C6 arm, respectively. Median progression-free survival was 16 and 21 weeks in the C3 and C6 groups, respectively (P=0.21, HR 0.86, 95% CI 0.68–1.08). In conclusion, palliative chemotherapy with carboplatin and vinorelbine beyond three courses conveys no survival or consistent QoL benefits in advanced NSCLC.Keywords
This publication has 52 references indexed in Scilit:
- Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of lifeThorax, 2004
- Direct Treatment Costs for Patients with Lung Cancer from First Recurrence to Death in FrancePharmacoEconomics, 2003
- Patterns, costs and cost-effectiveness of care in a trial of chemotherapy for advanced non-small cell lung cancerLung Cancer, 2002
- Quality of life and survival in patients with advanced non-small cell lung cancer receiving supportive care plus chemotherapy with carboplatin and etoposide or supportive care only. A multicentre randomised phase III trialEuropean Journal Of Cancer, 1998
- 180 Additional treatment does not improve the survival of locally advanced or metastatic NSCLC patients who responded after two courses of cisplatin (C), vindesin (V), mitomycin (M) chemotherapyLung Cancer, 1997
- Vinorelbine is well tolerated and active in the treatment of elderly patients with advanced non-small cell lung cancer. A two-stage phase II studyEuropean Journal Of Cancer, 1997
- Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapyEuropean Journal Of Cancer, 1995
- The EORTC QLQ-LC13: a modular supplement to the EORTC core quality of life questionnaire (QLQ-C30) for use in lung cancer clinical trialsEuropean Journal Of Cancer, 1994
- The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in OncologyJNCI Journal of the National Cancer Institute, 1993
- Continuation of chemotherapy versus supportive care alone in patients with inoperable non-small cell lung cancer and stable disease after two or three cycles of MACC. Results of a randomized prospective studyCancer, 1989