The benefits and harms of adjuvant chemotherapy for non-small cell lung cancer in patients with major comorbidities: A simulation study.

Autor: Leiter A; Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Kong CY; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Gould MK; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America., Kale MS; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Veluswamy RR; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Smith CB; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Mhango G; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Huang BZ; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America., Wisnivesky JP; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Sigel K; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Nov 15; Vol. 17 (11), pp. e0263911. Date of Electronic Publication: 2022 Nov 15 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0263911
Abstrakt: Background: Randomized controlled trials (RCTs) have demonstrated a survival benefit for adjuvant platinum-based chemotherapy after resection of locoregional non-small cell lung cancer (NSCLC). The relative benefits and harms and optimal approach to treatment for NSCLC patients who have major comorbidities (chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], and congestive heart failure [CHF]) are unclear, however.
Methods: We used a simulation model to run in-silico comparative trials of adjuvant chemotherapy versus observation in locoregional NSCLC in patients with comorbidities. The model estimated quality-adjusted life years (QALYs) gained by each treatment strategy stratified by age, comorbidity, and stage. The model was parameterized using outcomes and quality-of-life data from RCTs and primary analyses from large cancer databases.
Results: Adjuvant chemotherapy was associated with clinically significant QALY gains for all patient age/stage combinations with COPD except for patients >80 years old with Stage IB and IIA cancers. For patients with CHF and Stage IB and IIA disease, adjuvant chemotherapy was not advantageous; in contrast, it was associated with QALY gains for more advanced stages for younger patients with CHF. For stages IIB and IIIA NSCLC, most patient groups benefited from adjuvant chemotherapy. However, In general, patients with multiple comorbidities benefited less from adjuvant chemotherapy than those with single comorbidities and women with comorbidities in older age categories benefited more from adjuvant chemotherapy than their male counterparts.
Conclusions: Older, multimorbid patients may derive QALY gains from adjuvant chemotherapy after NSCLC surgery. These results help extend existing clinical trial data to specific unstudied, high-risk populations and may reduce the uncertainty regarding adjuvant chemotherapy use in these patients.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MKG has received royalties from UpToDate and research support through his institution from Medial EarlySign. RRV has served on advisory boards for Bristol-Myers Squibb, Astrazeneca, Merck, Novocure, BerGenBio, and Regeneron; on unbranded speaker’s bureau of Astrazeneca, received consulting honorarium from Beigene and Novartis, and research grants from BMS, Astrazeneca, Onconova Therapeutics and Boehringer Ingelheim. CBS reports honoraria from Astra Zeneca JPW reports consulting honoraria from Atea, Sanofi, and Banook, and PPD and research grants from Sanofi, Regeneron and Arnold Consultants. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
(Copyright: © 2022 Leiter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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