Abstract
Introduction: The gold standard endpoint for studying the efficiency of chemotherapy in lung cancer is overall survival (OS). Although reliable and simple to measure, this endpoint takes years to observe. Surrogate endpoints that would enable earlier assessments of treatment effects, yielding an added opportunity to adapt treatment would be useful.
Aim: To assess objective response after 1st and 2nd line chemotherapy (CT) as a surrogate for survival in a series of 202 consecutive patients with stage IIIB/IV NSCLC, presenting from Jan, 1st, 2008 through Dec, 31st, 2012 to our pulmonology department.
Results: Objective response to chemotherapy was scored as Response/Stable (RS) or Progression (P). Following 1st line CT, RS occurred in 60.4% and P in 39.6%. Survival by Kaplan-Meier analysis based on these criteria following 1st line CT, yielded 2 statistically different survival curves (p<0.001) with an unexpected mean OS of 421.736 ± 61.99 days (d) for RS versus 480.291 ± 32.178 d for P. Following 2nd line CT, RS occurred in 15.4% and P in 84.6%. Survival by Kaplan-Meier following 2nd line CT showed separate survival curves favoring the RS group with an OS of 707.313 ± 99.63 d versus 499.205 ± 35.93 d for the P group (p = 0.063).
Conclusion: This study demonstrates objective response following 2nd line CT to be a predictor of survival while response following 1st line CT seems to be deceptively indicating a worse prognosis. This may be due to non-responders after 1st line CT taking benefit from early 2nd line salvage therapy while responders after 1st line CT are prone to a delayed assessment for progression.
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