Comparative effectiveness of three platinum‐doublet chemotherapy regimens in elderly patients with advanced non–small cell lung cancer

Cancer - Tập 119 Số 11 - Trang 2048-2060 - 2013
Junya Zhu1, Dhruv Sharma2, Aileen B. Chen3, Bruce E. Johnson4,5, Jane C. Weeks4,5, Deborah Schrag4,5
1Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts
2Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
3Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
4Department of Internal Medicine, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
5Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts

Tóm tắt

BACKGROUNDRandomized trials report equivalent efficacy among various combinations of platinum‐based regimens in advanced non–small cell lung cancer (NSCLC). Their relative effectiveness and comparability based on squamous versus nonsquamous histology is uncertain.METHODSThe authors used the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked data to identify first‐line chemotherapy agents administered to Medicare beneficiaries with stage IIIB or IV NSCLC diagnosed from 2000 to 2007. Overall survival was compared between patients who received the 3 most common regimens: carboplatin‐paclitaxel, carboplatin‐gemcitabine, and carboplatin‐docetaxel. Stratified analyses distinguished between the outcomes of patients with squamous versus nonsquamous cell histology. Multivariable Cox proportional hazards models and propensity score analyses facilitated adjustment for imbalance in measurable patient characteristics.RESULTSOf the 15,318 patients who received first‐line chemotherapy, 43.1% received carboplatin‐paclitaxel, 14.3% received carboplatin‐gemcitabine, 8.5% received carboplatin‐docetaxel, and 34.1% received other regimens. The median survival was 8.0 months (interquartile range [IQR], 3.5‐17.4 months) for carboplatin‐paclitaxel, 7.3 months (IQR, 3.4‐15.2 months) for carboplatin‐gemcitabine, and 7.5 months (IQR, 3.2‐16.0 months) for carboplatin‐docetaxel. Both multivariable and propensity score‐adjusted Cox models demonstrated a slight inferiority associated with carboplatin‐gemcitabine or carboplatin‐docetaxel versus carboplatin‐paclitaxel, with a hazard ratio of 1.10 (95% confidence interval, 1.04‐1.15) and 1.09 (95% confidence interval, 1.02‐1.16), respectively, in propensity score‐stratified models. Among the subgroup of 2063 patients with squamous carcinoma, propensity score‐stratified analyses had a higher risk of death (hazard ratio, 1.20; 95% confidence interval, 1.07‐1.35) associated with carboplatin‐gemcitabine versus carboplatin‐paclitaxel.CONCLUSIONSCarboplatin‐paclitaxel was associated with slightly better survival compared with carboplatin‐gemcitabine or carboplatin‐docetaxel within the Medicare population with advanced NSCLC, and this was most pronounced for patients who had squamous cell histology. Cancer 2013;119:2048–2060. © 2013 American Cancer Society.

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Cancer

Tập 119 Số 11

2048-2060

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