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Lack of initial response to chemoradiotherapy linked to poorer outcome
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Patients with small cell lung cancer who did not achieve complete/partial response after their first course of platinum-based chemoradiotherapy experienced a poorer outcome, despite eventually obtaining an objective response throughout the treatment course, study results showed.
“Historically, in many malignancies, measurement of objective response could be the effective tool for predicting overall survival,” the researchers wrote. “In the treatment of [limited stage]-SCLC, the high response rate is expected (80%-90%), but this favorable radiological efficacy does not seem to correspond to the survival benefit, with a 5-year survival rate of only around 20%. It means that even not all responders are expected to have a better survival.”
In previous studies, slow tumor regression after the initiation of chemoradiotherapy was significantly associated with poor treatment outcome in advanced non–small cell lung cancer patients who obtained objective response to the initial chemoradiotherapy.
Based on study observation, the researchers evaluated whether the timing of obtaining tumor regression with first-line chemoradiotherapy could affect the prognosis in limited stage-SCLC patients who eventually achieved the objective response through the treatment courses.
The researchers retrospectively reviewed medical charts of 70 patients diagnosed with untreated, pathologically documented limited-stage SCLC who had obtained either a complete response or partial response with the three or four cycles of first-line chemoradiotherapy between July 1988 and December 2006 at the Okayama University Hospital in Okayama, Japan.
According to the review, 52 patients (74.3%) attained early tumor regression, 25 of whom exhibited complete response and 27 who achieved partial response. The 2-year survival rates of these responders (72.3%) were longer than those of the remaining 18 patients (7.1%) who did not achieve complete/partial response at the end of first cycle (P<.001).
Five-year survival was 67.7% among early responders vs. 0% for patients who did not attain complete/partial response.
Cox regression analysis showed that the early response to the treatment was a significant prognostic factor (HR=0.098; 95% CI, 0.036-0.269).
“These results would support our findings, suggesting that, in lung cancer patients, those without early tumor progression might have a poorer outcome, even though the objective response is finally confirmed through the treatment course of the chemoradiotherapy,” the researchers wrote. “Considering this obvious survival difference between the early and late tumor regression groups, the issue as to how fast tumor could regress after the initial exposure to cytotoxic agents would be clinically important.”
Disclosure: The researchers report honoraria for lecturing from Sanofi-Aventis Japan, Nihon Kayaku, Lilly Japan and Chugai Pharmaceutical.
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