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. 2016 Nov;7(6):655-662.
doi: 10.1111/1759-7714.12381. Epub 2016 Aug 1.

Clinical impact of post-progression survival on overall survival in elderly patients with extensive disease small-cell lung cancer

Hisao Imai  1 , Keita Mori  2 , Nodoka Watase  3 , Toshifumi Kazama  4 , Sakae Fujimoto  5 , Kyoichi Kaira  6 , Masanobu Yamada  7 , Koichi Minato  5
Affiliations

Clinical impact of post-progression survival on overall survival in elderly patients with extensive disease small-cell lung cancer

Hisao Imai et al. Thorac Cancer. 2016 Nov.

Abstract

Background: The effects of first-line chemotherapy on overall survival (OS) might be confounded by subsequent therapies in patients with small-cell lung cancer (SCLC). Therefore, the objective of our study was to determine the relationships between progression-free survival (PFS) or post-progression survival (PPS) and OS after first-line chemotherapy in elderly patients with extensive disease-SCLC (ED-SCLC), using individual level data.

Methods: Between July 1998 and December 2014, we analyzed 57 cases of elderly patients with ED-SCLC who were treated with carboplatin and etoposide as first-line chemotherapy. The relationships between PFS and PPS with OS were analyzed at an individual level.

Results: Spearman rank correlation and linear regression analyses showed that PPS was strongly correlated with OS (r = 0.92, P < 0.05, R 2 = 0.83) and PFS was moderately correlated with OS (r = 0.76, P < 0.05, R 2 = 0.25). The best response at second-line treatment and the number of regimens after progression beyond first-line chemotherapy were both significantly associated with PPS (P < 0.05).

Conclusions: PPS has a stronger impact on OS than PFS in elderly ED-SCLC patients after first-line chemotherapy. In addition, the response at second-line treatment and the number of additional regimens after first-line treatment are significant independent prognostic factors for PPS. These results suggest that OS in elderly ED-SCLC patients may be influenced by treatments subsequent to first-line chemotherapy; however, this remains to be verified with prospective studies.

Keywords: Elderly; extensive disease small-cell lung cancer; overall survival; post-progression survival; progression-free survival.

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Figures

Figure 1
Figure 1
(a) Kaplan–Meier plots showing progression‐free survival (PFS). Median PFS: 4.2 months. (b) Kaplan–Meier plots showing overall survival (OS). Median overall survival: 8.2 months. (#) There was 1 outlier in these data.
Figure 2
Figure 2
(a) Correlation between overall survival (OS) and progression‐free survival (PFS). (b) Correlation between overall survival (OS) and post‐progression survival (PPS). (#) There were 2 outliers in these data. *The r values represent Spearman's rank correlation coefficient. **The R2 values represent linear regression.
Figure 3
Figure 3
Progression‐free survival (PFS) and post‐progression survival (PPS) in the overall population.
Figure 4
Figure 4
(a) Kaplan‐Meier plots showing post‐progression survival (PPS), according to the best response following second‐line treatment. Non‐progressive disease (non‐PD), median = 7.8 months; progressive disease (PD), median = 3.7 months. (b) Kaplan–Meier plots showing post‐progression survival (PPS), according to the number of regimens after progression. No further regimen, median = 1.5 months; 1 regimen, median = 4.4 months; ≥ 2 regimens, median = 8.3 months. (#) There was 1 outlier in these data.
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