Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy

Stalin Bala; Sadashivudu Gundeti; Vijay Gandhi Linga; Lakshmi Srinivas Maddali; Raghunadha Rao Digumarti; Shantveer G Uppin

doi:10.4103/0971-5851.195735

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(04): 242-250
DOI: 10.4103/0971-5851.195735

ORIGINAL ARTICLE

Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy

Authors

Stalin Bala

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Sadashivudu Gundeti

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Vijay Gandhi Linga

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Lakshmi Srinivas Maddali

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Raghunadha Rao Digumarti

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Shantveer G Uppin

Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Abstract

PDF Download

Abstract

Context: Lung cancer is an important cause of cancer-related deaths worldwide. There is an increasing incidence of lung cancer in never smokers and a shift of histology from squamous cell to adenocarcinoma globally in the recent past. Data on treatment outcomes with newer platinum doublets is scant from India. Aims: To study the clinicopathological features, response rates (RRs), progression-free survival (PFS), overall survival (OS), and the 1, 2, and 3 years survival, in patients with advanced nonsmall cell lung cancer (NSCLC). Materials and Methods: Data of all patients who received chemotherapy for Stage IIIB and IV NSCLC between January 2010 and June 2014 were retrospectively analyzed. Statistical Analysis Used: Univariate analysis for OS was done by plotting Kaplan–Meier curves and the log-rank test was used to calculate P values. Logistic regression analysis for OS was carried out using MedCalc statistical software. Results: A total of 353 patients received chemotherapy. Of these, 256 were evaluable for outcome parameters. The median age at presentation was 58 years with a male:female ratio of 2.53:1. The smoker:nonsmoker ratio was 1:1. Adenocarcinomatous histology was the most common both in smokers and nonsmokers reported in 70.8% patients. Epidermal growth factor receptor (EGFR) mutation and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase translocation were seen in 35% and 3% of patients, respectively. The RR, median PFS, OS, 1, 2, and 3 years survival were 80%, 8 months, 12.1 months, 51.5%, 12.7%, and 4.2%, respectively. There was no significant survival difference among the treatment regimen used but the response to I line chemotherapy impacted survival. Female gender, performance status, and nonsquamous histology were significant predictors of OS (P = 0.0443, P = 0.0003, P = 0.048, respectively). Conclusions: There was an increase in the incidence of nonsmokers. Adenocarcinoma was the most common histology in both smokers and nonsmokers. Treatment outcomes in advanced lung cancer were better compared to the past with the advent of newer platinum doublets and EGFR tyrosine kinase inhibitors. The response to first-line chemotherapy significantly impacts outcomes in advanced NSCLC.

Keywords

Epidermal growth factor receptor - nonsmall cell lung cancer - platinum doublet - survival

PDF (1334 kb)

References

References
1 Detterbeck FC, Decker RH, Tanoue L, Lilenbaum RC. Non-small cell lung cancer. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 4th ed. Philadelphia: Wolters Kluwer; 2015. p. 495-535.
2 Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 2008;100:1672-94.
3 Kanavos P. The rising burden of cancer in the developing world. Ann Oncol 2006;17 Suppl 8:viii15-23.
4 GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Lung Cancer [Database on the internet]. International Agency for Research on Cancer, World Health Organization; 2013. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. [Last cited on 2014 Jan 08].
5 Toh CK, Gao F, Lim WT, Leong SS, Fong KW, Yap SP, et al. Never-smokers with lung cancer: Epidemiologic evidence of a distinct disease entity. J Clin Oncol 2006;24:2245-51.
6 Samet JM, Avila-Tang E, Boffetta P, Hannan LM, Olivo-Marston S, Thun MJ, et al. Lung cancer in never smokers: Clinical epidemiology and environmental risk factors. Clin Cancer Res 2009;15:5626-45.
7 Devesa SS, Bray F, Vizcaino AP, Parkin DM. International lung cancer trends by histologic type: Male:Female differences diminishing and adenocarcinoma rates rising. Int J Cancer 2005;117:294-9.
8 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.
9 Rosell R, Moran T, Queralt C, Porta R, Cardenal F, Camps C, et al. Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 2009;361:958-67.
10 Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med 2010;363:1693-703.
11 Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008;26:3543-51.
12 Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009;361:947-57.
13 Sequist LV, Martins RG, Spigel D, Grunberg SM, Spira A, Jänne PA, et al. First-line gefitinib in patients with advanced non-small-cell lung cancer harboring somatic EGFR mutations. J Clin Oncol 2008;26:2442-9.
14 Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, et al. Geftinib or chemotherapy for non-small cell lung cancer with mutated EGFR. N Engl J Med 2010;362:2380-8.
15 Sequist LV, Joshi VA, Jänne PA, Muzikansky A, Fidias P, Meyerson M, et al. Response to treatment and survival of patients with non-small cell lung cancer undergoing somatic EGFR mutation testing. Oncologist 2007;12:90-8.
16 Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007;2:706-14.
17 Socinski MA, Bondarenko I, Karaseva NA, Makhson AM, Vynnychenko I, Okamoto I, et al. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non-small-cell lung cancer: Final results of a phase III trial. J Clin Oncol 2012;30:2055-62.
18 Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47.
19 Krishnamurthy A, Vijayalakshmi R, Gadigi V, Ranganathan R, Sagar TG. The relevance of “Nonsmoking-associated lung cancer” in India: A single-centre experience. Indian J Cancer 2012;49:82-8.
20 Noronha V, Dikshit R, Raut N, Joshi A, Pramesh CS, George K, et al. Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience. Indian J Cancer 2012;49:74-81.
21 Gao YT, Blot WJ, Zheng W, Ershow AG, Hsu CW, Levin LI, et al. Lung cancer among Chinese women. Int J Cancer 1987;40:604-9.
22 Shimizu H, Tominaga S, Nishimura M, Urata A. Comparison of clinico-epidemiological features of lung cancer patients with and without a history of smoking. Jpn J Clin Oncol 1984;14:595-600.
23 Jindal SK, Malik SK, Dhand R, Gujral JS, Malik AK, Datta BN. Bronchogenic carcinoma in Northern India. Thorax 1982;37:343-7.
24 Dey A, Biswas D, Saha SK, Kundu S, Kundu S, Sengupta A. Comparison study of clinicoradiological profile of primary lung cancer cases: An Eastern India experience. Indian J Cancer 2012;49:89-95.
25 Behera D, Balamugesh T. Lung cancer in India. Indian J Chest Dis Allied Sci 2004;46:269-81.
26 Bhatt AD, Pai R, Rebekah G, Nehru GA, Dhananjayan S, Samuel A, et al. Clinicopathologic features of non-small cell lung cancer in India and correlation with epidermal growth factor receptor mutational status. Indian J Cancer 2013;50:94-101.
27 Veldore VH, Rao RM, Kakara S, Pattanayak S, Tejaswi R, Sahoo R, et al. Epidermal growth factor receptor mutation in non-small-cell lung carcinomas: A retrospective analysis of 1036 lung cancer specimens from a network of tertiary cancer care centers in India. Indian J Cancer 2013;50:87-93.
28 Choughule A, Noronha V, Joshi A, Desai S, Jambhekar N, Utture S, et al. Epidermal growth factor receptor mutation subtypes and geographical distribution among Indian non-small cell lung cancer patients. Indian J Cancer 2013;50:107-11.
29 Mehta J. Molecular epidemiology of epidermal growth factor receptor mutations in lung cancers in Indian population. Indian J Cancer 2013;50:102-6.
30 Doval D, Prabhash K, Patil S, Chaturvedi H, Goswami C, Vaid A, et al. Clinical and epidemiological study of EGFR mutations and EML4-ALK fusion genes among Indian patients with adenocarcinoma of the lung. Onco Targets Ther 2015;8:117-23.
31 Rajappa S, Gundeti S, Talluri MR, Digumarti R. Chemotherapy for advanced lung cancer: A 5-year experience. Indian J Cancer 2008;45:20-6.
32 Johnson KR, Ringland C, Stokes BJ, Anthony DM, Freemantle N, Irs A, et al. Response rate or time to progression as predictors of survival in trials of metastatic colorectal cancer or non-small-cell lung cancer: A meta-analysis. Lancet Oncol 2006;7:741-6.
33 Sirohi B, Ashley S, Norton A, Popat S, Hughes S, Papadopoulos P, et al. Early response to platinum-based first-line chemotherapy in non-small cell lung cancer may predict survival. J Thorac Oncol 2007;2:735-40.