ABSTRACT
OBJECTIVE: Treatment options for non-small-cell lung cancer (NSCLC) have been evolving. The goal of our study was to evaluate whether novel therapeutics are used in the elderly population and improve outcomes to a similar extent as in young patients. METHODS: We enrolled patients registered in the Cancer Registry of Eastern Switzerland and grouped them into four cohorts: Elderly patients aged ≥70 years diagnosed 2005-2007 and 2015-2016 (elderly cohorts 1,2) were compared to cohorts of patients < 70 years diagnosed during the same time periods (young cohorts 1,2). RESULTS: 499 individuals were analysed. Median cancer-specific survival in the elderly cohorts 1 and 2 was 3.9 months and 6.3 months, respectively, and 8.0 and 12.7 months in the young cohorts 1 and 2. 12-month survival significantly improved over ten years only in younger patients (35.6% and 54.9%), however not in the elderly cohorts (20% vs. 35%). Proportion of patients receiving any line of systemic treatment remained lower in the elderly cohorts (53% vs. 78%). CONCLUSION: Despite the increase in median cancer-specific survival in both cohorts, a significant and clinically meaningful improvement of 12-month cancer-specific survival was only seen in young patients. The adoption of novel treatment approaches is lagging behind in the elderly population.
Subject(s)
Antineoplastic Agents, Immunological/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/therapeutic use , Survival Rate/trends , Adenocarcinoma of Lung/drug therapy , Adenocarcinoma of Lung/mortality , Adenocarcinoma of Lung/secondary , Age Factors , Aged , Cancer Care Facilities , Carcinoma, Large Cell/drug therapy , Carcinoma, Large Cell/mortality , Carcinoma, Large Cell/secondary , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/secondary , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/secondary , Cohort Studies , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Metastasis , Platinum Compounds/administration & dosage , SwitzerlandABSTRACT
BACKGROUND: The objective of study was to determine the effect of anthracycline dose reduction and chemotherapy delays on 5-year overall survival in patients with stage I-III breast cancer, to establish the impact of molecular subtypes on the anthracycline modification effects and to analyze reasons for such chemotherapy scheme modifications. METHODS: Medical records of patients with stage I-III breast cancer were reviewed. Inclusion criteria involved stage I- III breast carcinoma; radical surgery performed and 4 courses of AC regimen (doxorubicin and cyclophosphamide), or at least 6 courses of FAC regimen (fluorouracil, doxorubicin and cyclophosphamide) completed; no neoadjuvant chemotherapy applied; no taxane group medications administered; medical records maintain comprehensive data on treatment and follow-up. 5- year overall survival were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Significant 3.17 times higher death risk at 5 year period in patients who experienced anthracycline dose reduction compared with patients who did not experience any modifications was established (HR = 3.17, 95% CI 1.7-5.9, p < 0.001). Increased death risk in patients who experienced both chemotherapy dose reduction and treatment delays compared with patients who did not experience any modifications was also established (HR = 2.76, 95% CI 1.3-5.6, p < 0.05). 5- year overall survival was affected by anthracycline dose reduction by more than 15% in ER-HER2- group (80% v. 55.6%, p = 0.015), ER + HER2- group (90.7% v. 64.9%, p < 0.01) and ER+/-HER2+ group (100% v. 84.4%, p = 0.019). 5-year overall survival was affected by chemotherapy delays more than 2 cycles in ER-HER2- group (79.2% v. 51.4%, p = 0.002), ER + HER2- group (86.3% v. 58.8%, p = 0.014) and there was no difference in ER+/-HER2+ group. Main reasons for chemotherapy scheme modifications (in decreasing order) were the following: neutropenia, modifications with no objective medical reasons, thrombocytopenia, anaemia, fatigue, infection. CONCLUSIONS: Anthracycline dose reduction in patients with stage I- III breast cancer were associated with higher mortality risk and significantly decreased 5- year absolute survival in all molecular subtypes. Chemotherapy delays alone were not associated with decreased survival only in HER2 positive subtype. The most common reason for dose reduction or chemotherapy delays was neutropenia.