Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies

Thomas E. Stinchcombe, Ying Zhang, Everett E. Vokes, Joan H. Schiller, Jeffrey D. Bradley, Karen Kelly, Walter J. Curran, Steven E. Schild, Benjamin Movsas, Gerald Clamon, Ramaswamy Govindan, George R. Blumenschein, Mark A. Socinski, Neal E. Ready, Wallace L. Akerley, Harvey J. Cohen, Herbert H. Pang, Xiaofei Wang

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Abstract

Purpose: Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods: Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results: A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P<.01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion: Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.

Original languageEnglish (US)
Pages (from-to)2885-2892
Number of pages8
JournalJournal of Clinical Oncology
Volume35
Issue number25
DOIs
StatePublished - Sep 1 2017

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National Cancer Institute (U.S.)
Chemoradiotherapy
Non-Small Cell Lung Carcinoma
Survival
Odds Ratio
Disease-Free Survival
Therapeutics
Consolidation Chemotherapy
Induction Chemotherapy
Proportional Hazards Models

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies. / Stinchcombe, Thomas E.; Zhang, Ying; Vokes, Everett E.; Schiller, Joan H.; Bradley, Jeffrey D.; Kelly, Karen; Curran, Walter J.; Schild, Steven E.; Movsas, Benjamin; Clamon, Gerald; Govindan, Ramaswamy; Blumenschein, George R.; Socinski, Mark A.; Ready, Neal E.; Akerley, Wallace L.; Cohen, Harvey J.; Pang, Herbert H.; Wang, Xiaofei.

In: Journal of Clinical Oncology, Vol. 35, No. 25, 01.09.2017, p. 2885-2892.

Research output: Contribution to journalArticle

Stinchcombe, TE, Zhang, Y, Vokes, EE, Schiller, JH, Bradley, JD, Kelly, K, Curran, WJ, Schild, SE, Movsas, B, Clamon, G, Govindan, R, Blumenschein, GR, Socinski, MA, Ready, NE, Akerley, WL, Cohen, HJ, Pang, HH & Wang, X 2017, 'Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies', Journal of Clinical Oncology, vol. 35, no. 25, pp. 2885-2892. https://doi.org/10.1200/JCO.2016.71.4758
Stinchcombe, Thomas E. ; Zhang, Ying ; Vokes, Everett E. ; Schiller, Joan H. ; Bradley, Jeffrey D. ; Kelly, Karen ; Curran, Walter J. ; Schild, Steven E. ; Movsas, Benjamin ; Clamon, Gerald ; Govindan, Ramaswamy ; Blumenschein, George R. ; Socinski, Mark A. ; Ready, Neal E. ; Akerley, Wallace L. ; Cohen, Harvey J. ; Pang, Herbert H. ; Wang, Xiaofei. / Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies. In: Journal of Clinical Oncology. 2017 ; Vol. 35, No. 25. pp. 2885-2892.
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title = "Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies",
abstract = "Purpose: Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods: Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results: A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95{\%} CI, 1.09 to 1.31 and HR, 1.17; 95{\%} CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95{\%} CI, 0.93 to 1.10 and HR, 1.00; 95{\%} CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95{\%} CI, 1.07 to 1.70 and OR, 1.38; 95{\%} CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9{\%} v 4{\%}; P<.01). Fewer elderly compared with younger patients completed treatment (47{\%} v 57{\%}; P < .01), and more discontinued treatment because of AEs (20{\%} v 13{\%}; P < .01), died during treatment (7.8{\%} v 2.9{\%}; P < .01), and refused further treatment (5.8{\%} v 3.9{\%}; P = .02). Conclusion: Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.",
author = "Stinchcombe, {Thomas E.} and Ying Zhang and Vokes, {Everett E.} and Schiller, {Joan H.} and Bradley, {Jeffrey D.} and Karen Kelly and Curran, {Walter J.} and Schild, {Steven E.} and Benjamin Movsas and Gerald Clamon and Ramaswamy Govindan and Blumenschein, {George R.} and Socinski, {Mark A.} and Ready, {Neal E.} and Akerley, {Wallace L.} and Cohen, {Harvey J.} and Pang, {Herbert H.} and Xiaofei Wang",
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TY - JOUR

T1 - Pooled analysis of individual patient data on concurrent chemoradiotherapy for stage III non-small-cell lung cancer in elderly patients compared with younger patients who participated in US national cancer institute cooperative group studies

AU - Stinchcombe, Thomas E.

AU - Zhang, Ying

AU - Vokes, Everett E.

AU - Schiller, Joan H.

AU - Bradley, Jeffrey D.

AU - Kelly, Karen

AU - Curran, Walter J.

AU - Schild, Steven E.

AU - Movsas, Benjamin

AU - Clamon, Gerald

AU - Govindan, Ramaswamy

AU - Blumenschein, George R.

AU - Socinski, Mark A.

AU - Ready, Neal E.

AU - Akerley, Wallace L.

AU - Cohen, Harvey J.

AU - Pang, Herbert H.

AU - Wang, Xiaofei

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Purpose: Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods: Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results: A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P<.01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion: Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.

AB - Purpose: Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods: Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results: A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P<.01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion: Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.

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DO - 10.1200/JCO.2016.71.4758

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