Adjuvant chemotherapy associated with shorter survival in LCNEC

SEATTLE — Patients who underwent adjuvant chemotherapy for pulmonary large cell neuroendocrine carcinomas demonstrated poorer 3-year survival than those who did not undergo adjuvant treatment, according to study results presented at the American Association for Thoracic Surgery Annual Meeting.

“We did not see any particular subset of patients who may benefit from this treatment,” researcher Pier Luigi Filosso, MD, of the University of Torino in Italy, said during a presentation.

Filosso and colleagues conducted a retrospective cohort study to determine the impact of adjuvant chemotherapy in patients with resected large cell neuroendocrine carcinomas (LCNEC). The analysis included 400 patients with LCNEC who underwent surgery between 1992 and 2014 at one of 14 institutions worldwide.

Researchers used the Kaplan-Meier method to estimate OS after resection. Propensity score for the likelihood of receipt of adjuvant chemotherapy was estimated based on patient age, gender, prior malignancy, ECOG performance status, TNM stage and year of surgery.

Slightly more than one-third (37%) of patients in the cohort received adjuvant chemotherapy.

Median follow-up was 38 months.

At the time of analysis, 213 patients had died, 69 of whom had received adjuvant chemotherapy.

Researchers reported a lower rate of 3-year OS among patients who received adjuvant chemotherapy compared with those who did not receive adjuvant chemotherapy (47% vs. 51%).

Propensity score-adjusted analyses showed no significant survival benefit associated with adjuvant chemotherapy (adjusted HR = 0.82; 95% CI, 0.62-1.09).

Multivariate analysis showed older age at resection (HR for each 1-year increase in age = 1.03; 95% CI, 1.01-1.05) and higher ECOG performance status (HR for ECOG status ≥ 2 = 1.62; 95% CI, 1.21-2.16) were associated with increased mortality risk.

Researchers also observed an association between cancer stage and survival. Patients with stage III or stage IV disease demonstrated an elevated risk for mortality compared with patients with stage I disease (HR = 2.57; 95% CI, 1.76-3.76).

“We believe prospective data collection … will hopefully help to define more tailored treatment strategies for such a rare and aggressive neoplasm,” Filosso said. – by Ryan McDonald

Reference:

Filosso PL, et al. Abstract 21. Presented at: American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Filosso reports no relevant financial disclosures.