No Survival Difference but Greater Morbidity With Etoposide/Cisplatin vs Carboplatin/Paclitaxel With Concurrent Radiotherapy for Stage III NSCLC
In an analysis of Veterans Health Administration data reported in the Journal of Clinical Oncology, Santana-Davila et al found that etoposide/cisplatin resulted in no overall survival difference but greater morbidity compared with carboplatin/paclitaxel used concurrently with radiotherapy in patients with stage III non–small cell lung cancer (NSCLC).
No Overall Survival Difference
The analysis involved 1,842 patients treated with etoposide/cisplatin (n = 499) or carboplatin/paclitaxel (n = 1,343) between 2001 and 2010. In a Cox proportional hazard model, age (hazard ratio [HR] = 1.08, P = .0258), percentage weight loss (HR = 1.04, P < .0001), baseline anemia (HR = 1.19, P = .0064), hypoalbuminemia (HR = 1.29; 95% confidence interval [CI] = 1.14–1.46; P < .001), and treatment era (HR = 0.89 for 2005-2007 and 0.83 for 2008-2010 vs 2001-2004, P = .028) were independently associated with overall survival, whereas chemotherapy regimen (median overall survival = 17.3 months for etoposide/cisplatin vs 14.6 months for carboplatin/paclitaxel, HR = 0.97, P = .6327), stage (HR = 1.08, P = .185, for IIIB vs IIIA), and National Cancer Institute combined index score (HR = 1.17, P = .0503) were not associated with survival.
Treatment with etoposide/cisplatin was also not associated with significantly different overall survival in a propensity score-matched cohort (HR = 1.07, 95% CI = 0.91–1.24) or in a propensity score-adjusted model (HR = 0.97, 95% CI = 0.85–1.10). There was no survival advantage for patients treated in centers where etoposide/cisplatin was used in > 50% vs < 10% of patients (HR = 1.07, 95% CI = 0.90–1.26).
Greater Morbidity
Patients treated with etoposide/cisplatin had more hospitalizations (mean 2.4 vs 1.7, P < .001), outpatient visits (mean 17.6 vs 12.6, P < .001), infectious complications (47.3% vs 39.4%, P = .0022), acute kidney injury/dehydration (30.5% vs 21.2%, P < .001), and mucositis/esophagitis (18.6% vs 14.4%, P = .0246).
The investigators concluded: “After accounting for prognostic variables, patients treated with [etoposide/cisplatin vs carboplatin/paclitaxel] had similar overall survival, but [etoposide/cisplatin] was associated with increased morbidity.”
Rafael Santana-Davila, MD, of University of Washington, Seattle, is the corresponding author for the Journal of Clinical Oncology article. For full disclosures of the study authors, visit jco.ascopubs.org.
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