Six platinum cycles no better than four for advanced NSCLC

Oct 22 2014

By Lynda Williams, Senior medwireNews Reporter

Six cycles of adjuvant platinum-based chemotherapy is no better than three or four cycles for patients with advanced non-small-cell lung cancer (NSCLC), meta-analysis results suggests.

“Our findings suggest that to plan fewer than six cycles of first-line platinum-based chemotherapy is a valid treatment option for these patients”, say lead researcher Antonio Rossi (S.G. Moscati Hospital, Avellino, Italy) and colleagues.

The study, published in The Lancet Oncology, includes data from four clinical trials where 568 patients were assigned to receive six cycles of cisplatin or carboplatin and 571 patients were assigned to receive three or four courses.

There was no significant difference in the overall survival of the patients given six cycles compared with those given fewer cycles, at a median of 9.54 versus 8.68 months and a hazard ratio (HR) of 0.94.

Although there were slight differences in overall survival between the trials, the researchers were unable to identify patient subgroups who benefited from more cycles of chemotherapy than others, with no evidence that histology, age, gender or performance status predicted outcome.

Median progression-free survival was significantly longer in the patients given six versus fewer cycles, however, at 6.09 and 5.33 months (HR=0.79), respectively with no heterogeneity. And the objective response rate, available for 835 patients from three trials, was also significantly higher for six versus fewer cycles, at 41.3% versus 36.5% (relative risk=1.13).

Patients who received six cycles of chemotherapy were also more likely to have grade 3 or more severe anaemia, affecting 7.8% compared with 2.9% of those given fewer cycles, although there were no significant differences found for other types of toxicities.

“According to these results, no evidence exists to support the use of more than four cycles of platinum-based chemotherapy as first-line treatment of patients with advanced non-small-cell lung cancer”, the authors conclude.

Athanasios Kotsakis and Vassilis Georgoulias, from University General Hospital of Heraklion in Crete, write in an accompanying comment that the meta-analysis findings should be “interpreted with caution” due to differences in trial design of the four studies assessed.

Nevertheless, they say that the study “strengthens the view that the duration of chemotherapy should be personalised for every individual patient”, noting that discontinuing treatment after three or four cycles may not deprive patients of a significant treatment benefit.

“Instead, they might have a greater benefit from such an approach in terms of their quality of life”, comment Kotsakis and Georgoulias.

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