A population-based comparative effectiveness study of chemoradiation regimens and sequences in stage III non-small cell lung cancer

- Chemoradiation is used to treat many patients with stage III NSCLC.
- Carboplatin- and cisplatin-containing regimens resulted in similar outcomes.
- Consolidation chemotherapy after concurrent chemoradiation improved survival.
- Consolidation chemotherapy only benefited patients treated with carboplatin.
- When using carboplatin, consolidation chemotherapy should be considered.

ObjectivesIn patients receiving concurrent chemoradiation for locally advanced non-small cell lung cancer (NSCLC), consolidation chemotherapy is frequently given even though several randomized trials have failed to show a benefit. We explored the potential benefits of consolidation chemotherapy using a population-based comparative effectiveness approach.Materials and methodsSurveillance, Epidemiology, and End Results-Medicare was used to identify patients with Stage III NSCLC aged ≥65 and diagnosed 2002-2009. We selected patients who received concurrent chemoradiotherapy and determined whether they were (concurrent-consolidation) or were not (concurrent-alone) treated with consolidation chemotherapy. Outcomes were overall and cancer specific survival using a conditional landmark analysis approach.Results1688 patients treated with concurrent-alone or concurrent-consolidation were identified with a median follow up of 29 months. Choice of chemotherapy agents did not correlate with outcome. For concurrent-consolidation versus concurrent-alone, the median overall survival was 21 months versus 18 months, respectively (log-rank p = 0.008) and the median cancer specific survival was 23 months versus 19 months, respectively (log-rank p = 0.03). On multivariate analysis, concurrent-consolidation remained associated with improved overall survival (HR 0.85, p = 0.04), and there was a trend for improved cancer specific survival (HR 0.87, p = 0.12). Inverse probability of treatment weighting using propensity scores demonstrated similar findings. Importantly, the benefit of concurrent-consolidation held only for patients treated with carboplatin-taxane but not with cisplatin-etoposide.ConclusionSurvival outcomes were similar among the five most commonly employed platinum-based doublets. We found that patients receiving cisplatin during radiation do not appear to benefit from additional chemotherapy. However, for patients receiving carboplatin, consolidation chemotherapy was associated with improved overall and cancer specific survival.