Skip to main content
SpringerLink
Log in

Results of platinum-based chemotherapy in unselected performance status (PS) 2 patients with advanced non-small cell lung cancer: a cohort study

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Recent phase-III trials show that platinum-based chemotherapy (PBCT) for patients with advanced non-small cell lung cancer and poor performance status (PS) improves survival without increasing toxicity, compared to single-agent chemotherapy (CT). The aim of this study was to asses whether these results are transposable in a community population. About 260 consecutive patients with stage IIIB–IV NSCLC (25 % with PS 2) receiving a PBCT were prospectively included in the study and retrospectively analyzed. No difference was observed between PS 0–1 and 2 patients regarding tumor-control rate, symptom relief, and grade III–V toxicity. Median and 1-year survival of PS 2 patients was 6.2 months and 32 %, respectively. PS 1 and PS 2 patients continuing first-line CT beyond the first course shared the same survival. On the other hand, more PS 2 (31.8 vs. 9.3 % of PS 0–1 patients, p < 0.001) discontinued first-line CT after the first course with a poor clinical outcome. They were more likely to have lost weight and to have a high comorbidity score. PBCT in unselected PS 2 patients achieved survival rates similar to those observed in clinical trials, with no increase in toxicity. PS 2 patients continuing CT beyond the first course shared the same prognosis than PS 1 patients. However, almost one-third of PS 2 patients discontinued CT after the first course. Their prognosis was poor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Azzoli CG, Baker S, Temin S, Pao W, Aliff T, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol. 2009;27:6251–66.

    Article  PubMed  CAS  Google Scholar 

  2. D’Addario G, Früh M, Reck M, Baumann P, Klepetko W, Felip E. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v116–9.

    Article  PubMed  Google Scholar 

  3. Sculier J-P, Chansky K, Crowley JJ, Van Meerbeeck J, Goldstraw P. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th edition of the TNM classification of malignant tumors and the proposals for the 7th Edition. J Thorac Oncol. 2008;3:457–66.

    Article  PubMed  Google Scholar 

  4. Bunn PA. Chemotherapy for advanced non-small-cell lung cancer: who, what, when, why? J Clin Oncol. 2002;20:23S–33S.

    PubMed  CAS  Google Scholar 

  5. Gridelli C, Ardizzoni A, Le Chevalier T, Manegold C, Perrone F, Thatcher N, Van Zandwijk N, Di Maio M, Martelli O, De Marinis F. Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European experts panel. Ann Oncol. 2004;15:419–26.

    Article  PubMed  CAS  Google Scholar 

  6. Paesmans M, Sculier JP, Libert P, Bureau G, Dabouis G, Thiriaux J, Michel J, Van Cutsem O, Sergysels R, Mommen P. Prognostic factors for survival in advanced non-small-cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation algorithms in 1,052 patients. The European Lung Cancer Working Party. J Clin Oncol. 1995;13:1221–30.

    PubMed  CAS  Google Scholar 

  7. Lilenbaum RC, Cashy J, Hensing TA, Young S, Cella D. Prevalence of poor performance status in lung cancer patients: implications for research. J Thorac Oncol. 2008;3:125–9.

    Article  PubMed  Google Scholar 

  8. Tartarone A, Aieta M. Treatment of performance status 2 patients with advanced non-small-cell lung cancer: what we know and what we don’t know. Future Oncol. 2009;5:837–41.

    Article  PubMed  Google Scholar 

  9. Spiro SG, Rudd RM, Souhami RL, Brown J, Fairlamb DJ, Gower NH, Maslove L, Milroy R, Napp V, Parmar MKB, Peake MD, Stephens RJ, Thorpe H, Waller DA, West P. Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life. Thorax. 2004;59:828–36.

    Article  PubMed  CAS  Google Scholar 

  10. Sculier JP, Lafitte JJ, Paesmans M, Lecomte J, Alexopoulos CG, Van Cutsem O, Giner V, Efremidis A, Berchier MC, Collon T, Meert AP, Scherpereel A, Ninane V, Koumakis G, Vaslamatzis MM, Leclercq N, Berghmans T. Chemotherapy improves low performance status lung cancer patients. Eur Respir J. 2007;30:1186–92.

    Article  PubMed  CAS  Google Scholar 

  11. The Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 1999;91:66–72.

    Article  Google Scholar 

  12. Perrone F, Di Maio M, Gallo C, Gridelli C. Outcome of patients with a performance status of 2 in the Multicenter Italian Lung Cancer in the Elderly Study (MILES). J Clin Oncol. 2004;22:5018–20.; author reply 5020–5021.

    Article  PubMed  Google Scholar 

  13. Neubauer MA, Reynolds CH, Joppert MG, Whitaker T, Ghaddar H, Marsland TA, Asmar L. Results of a phase II trial of gemcitabine in patients with non-small-cell lung cancer and a performance status of 2. Clin Lung Cancer. 2005;6:245–9.

    Article  PubMed  CAS  Google Scholar 

  14. Lilenbaum R, Wang X, Gu L, Kirshner J, Lerro K, Vokes E. Randomized phase II trial of docetaxel plus cetuximab or docetaxel plus bortezomib in patients with advanced non-small-cell lung cancer and a performance status of 2: CALGB 30402. J Clin Oncol. 2009;27:4487–91.

    Article  PubMed  CAS  Google Scholar 

  15. Camerini A, Valsuani C, Mazzoni F, Siclari O, Puccetti C, Donati S, Rondini M, Tartarelli G, Puccinelli P, Di Costanzo F, Amoroso D. Phase II trial of single-agent oral vinorelbine in elderly (>or = 70 years) patients with advanced non-small-cell lung cancer and poor performance status. Ann Oncol. 2010;21:1290–5.

    Article  PubMed  CAS  Google Scholar 

  16. Baka S, Ashcroft L, Anderson H, Lind M, Burt P, Stout R, Dowd I, Smith D, Lorigan P, Thatcher N. Randomized phase II study of two gemcitabine schedules for patients with impaired performance status (Karnofsky performance status </=70) and advanced non-small-cell lung cancer. J Clin Oncol. 2005;23:2136–44.

    Article  PubMed  CAS  Google Scholar 

  17. Kosmidis PA, Dimopoulos M-A, Syrigos K, Nicolaides C, Aravantinos G, Boukovinas I, Pectasides D, Fountzilas G, Bafaloukos D, Bacoyiannis C, Kalofonos HP. Gemcitabine versus gemcitabine-carboplatin for patients with advanced non-small cell lung cancer and a performance status of 2: a prospective randomized phase II study of the Hellenic Cooperative Oncology Group. J Thorac Oncol. 2007;2:135–40.

    Article  PubMed  Google Scholar 

  18. Lilenbaum R, Villaflor VM, Langer C, O’Byrne K, O’Brien M, Ross HJ, Socinski M, Oldham FB, Sandilac L, Singer JW, Bonomi P. Single-agent versus combination chemotherapy in patients with advanced non-small cell lung cancer and a performance status of 2: prognostic factors and treatment selection based on two large randomized clinical trials. J Thorac Oncol. 2009;4:869–74.

    Article  PubMed  Google Scholar 

  19. Reynolds C, Obasaju C, Schell MJ, Li X, Zheng Z, Boulware D, Caton JR, Demarco LC, O’Rourke MA, Shaw Wright G, Boehm KA, Asmar L, Bromund J, Peng G, Monberg MJ, Bepler G. Randomized phase III trial of gemcitabine-based chemotherapy with in situ RRM1 and ERCC1 protein levels for response prediction in non-small-cell lung cancer. J Clin Oncol. 2009;27:5808–15.

    Article  PubMed  CAS  Google Scholar 

  20. Zwitter M, Kovac V, Rajer M, Vrankar M, Smrdel U. Two schedules of chemotherapy for patients with non-small cell lung cancer in poor performance status: a phase II randomized trial. Anticancer Drugs. 2010;21:662–8.

    Article  PubMed  CAS  Google Scholar 

  21. Lilenbaum R, Zukin M, Pereira JR, Barrios CH, De Aboulquerque Ribeiro R, De Mendonça Beato A, Neron do Nascimento Y, Murad A, Franke AF, Precivale M, De Lima Araujo LH, Da Rocha Baldotto CS, Meton Vieira F, Avila Small I, Fereira CGM. A randomized phase III trial of single-agent pemetrexed (P) versus carboplatin and pemetrexed (CP) in patients with advanced non-small cell lung cancer (NSCLC) and performance status (PS) of 2. ASCO. J Clin Oncol Off J Am Soc Clin Oncol 2012; suppl; abstr 7506.

  22. Vardy J, Dadasovich R, Beale P, Boyer M, Clarke SJ. Eligibility of patients with advanced non-small cell lung cancer for phase III chemotherapy trials. BMC Cancer. 2009;9:130.

    Article  PubMed  Google Scholar 

  23. Earle CC, Neumann PJ, Gelber RD, Weinstein MC, Weeks JC. Impact of referral patterns on the use of chemotherapy for lung cancer. J Clin Oncol. 2002;20:1786–92.

    Article  PubMed  Google Scholar 

  24. Langer CJ. Clinical evidence on the undertreatment of older and poor performance patients who have advanced non-small-cell lung cancer: is there a role for targeted therapy in these cohorts? Clin Lung Cancer. 2011;12:272–9.

    Article  PubMed  CAS  Google Scholar 

  25. Colinet B, Jacot W, Bertrand D, Lacombe S, Bozonnat M-C, Daurès J-P, Pujol J-L. A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson’s index. Br J Cancer. 2005;93:1098–105.

    Article  PubMed  CAS  Google Scholar 

  26. Klastersky J, Sculier JP, Ravez P, Libert P, Michel J, Vandermoten G, Rocmans P, Bonduelle Y, Mairesse M, Michiels T. A randomized study comparing a high and a standard dose of cisplatin in combination with etoposide in the treatment of advanced non-small-cell lung carcinoma. J Clin Oncol. 1986;4:1780–6.

    PubMed  CAS  Google Scholar 

  27. Klastersky J, Sculier JP, Dabouis G, Bureau G, Libert P, Ravez P, Vandermoten G, Thiriaux J, Lecomte J, Cordier R. A randomized trial of two platinum combinations in patients with advanced non-small cell lung cancer: a preliminary report. European Organization for the Research and Treatment of Cancer–Lung Cancer Working Party. Semin Oncol. 1990;17:20–4.

    PubMed  CAS  Google Scholar 

  28. Sculier JP, Klastersky J, Giner V, Bureau G, Thiriaux J, Dabouis G, Efremidis A, Ries F, Berchier MC, Sergysels R. Phase II randomized trial comparing high-dose cisplatin with moderate-dose cisplatin and carboplatin in patients with advanced non-small-cell lung cancer. European Lung Cancer Working Party. J Clin Oncol. 1994;12:353–9.

    PubMed  CAS  Google Scholar 

  29. Lilenbaum RC, Herndon JE 2nd, List MA, Desch C, Watson DM, Miller AA, Graziano SL, Perry MC, Saville W, Chahinian P, Weeks JC, Holland JC, Green MR. Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol. 2005;23:190–6.

    Article  PubMed  CAS  Google Scholar 

  30. Helbekkmo N, Aasebø U, Sundstrøm SH, Von Plessen C, Brunsvig PF, Bremnes RM. Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy. Lung Cancer. 2008;62:253–60.

    Article  PubMed  Google Scholar 

  31. Gioulbasanis I, Pallis A, Vlachostergios PJ, Xyrafas A, Giannousi Z, Perdikouri I-E, Makridou M, Kakalou D, Georgoulias V. The Glasgow Prognostic Score (GPS) predicts toxicity and efficacy in platinum-based treated patients with metastatic lung cancer. Lung Cancer. 2012;77:383–8.

    Article  PubMed  Google Scholar 

  32. Belani CP, Ramalingam S, Perry MC, LaRocca RV, Rinaldi D, Gable PS, Tester WJ. Randomized, phase III study of weekly paclitaxel in combination with carboplatin versus standard every-3-weeks administration of carboplatin and paclitaxel for patients with previously untreated advanced non-small-cell lung cancer. J Clin Oncol. 2008;26:468–73.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Dr Jean-Bernard Auliac and Pr Jean Tredaniel for their expert advice, as well as the helpful reviews of earlier versions of the manuscript, and wish to thank Dr Jean-Christophe Duboucher and Virginie Astruc for their help in data collection.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Service de Pneumologie et d’Oncologie Thoracique, CHI Poissy-Saint-Germain, 78100, Saint-Germain en Laye, France

    Stéphane Jouveshomme

  2. LIC EA4393 (Laboratoire d’Investigation Clinique), Faculté de médecine, Université Paris Est, 94010, Créteil, France

    Florence Canoui-Poitrine, Aurélie Le Thuaut & Sylvie Bastuji-Garin

  3. APHP, Hôpital Henri-Mondor, Pôle Recherche Clinique—santé Publique, 94010, Créteil, France

    Florence Canoui-Poitrine & Sylvie Bastuji-Garin

  4. Service de Pneumologie et d’Oncologie Thoracique, Groupe Hospitalier Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Stéphane Jouveshomme

Authors
  1. Stéphane Jouveshomme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florence Canoui-Poitrine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aurélie Le Thuaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sylvie Bastuji-Garin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stéphane Jouveshomme.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jouveshomme, S., Canoui-Poitrine, F., Le Thuaut, A. et al. Results of platinum-based chemotherapy in unselected performance status (PS) 2 patients with advanced non-small cell lung cancer: a cohort study. Med Oncol 30, 544 (2013). https://doi.org/10.1007/s12032-013-0544-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-013-0544-5

Keywords

Search

Navigation