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Chemotherapy improves low performance status lung cancer patients

¹ Institut Jules Bordet, ¹⁰ CHU Saint-Pierre, Brussels, Belgium, ³ CHU de Charleroi, Charleroi, ⁵ Clinique Saint-Luc, Bouge, ² CHRU Calmette, Lille, and ⁸ Hôpital de Hayange, Hayange, and ⁹ CHI Le Raincy, Montfermeil, France, ⁴ Evangelismos General Hospital and ⁷ Hellenic Cancer Institut, St Savas Hospital, Athens, Greece, ⁶ Hospital de Sagunto, Valencia, Spain.

CORRESPONDENCE: J. P. Sculier, Dept of Critical Care and Thoracic Oncology, Institut Jules Bordet, 1 rue Héger-Bordet, B-1000 Bruxelles, Belgium. Fax: 32 25343756. E-mail: sculier{at}bordet.be

Keywords: Cancer research, chemotherapy, nonsmall cell lung cancer, performance status

Received: March 22, 2007
Accepted July 25, 2007

The aim of the present study was to determine the potential benefit of conventional cisplatin-based chemotherapy on patients with advanced nonsmall cell lung cancer (NSCLC) and poor performance status (PS), defined as 60–70 on the Karnofsky scale.

Retrospective analysis was carried out of a randomised trial performed in advanced NSCLC where 485 patients received three courses of gemcitabine+ifosfamide+cisplatin induction chemotherapy.

Of the patients, 80% had good PS (Karnofsky 80–100) and 20% poor PS. Response rates were 38 and 28%, respectively. Clinical improvement, defined as achieving a good PS during chemotherapy, was observed overall in 25% of the poor PS patients, with rates of 38, 20 and 14%, respectively, in case of response, no change and progression. PS improved more quickly in the responders. Survival of patients with poor PS was significantly worse, but survival of responders was similar, irrespective of the initial poor or good PS. Although nonfatal toxicity was almost similar, there were more toxic deaths (including vascular and cardiac fatalities) in the poor PS patients (9.2 versus 2.1%).

In conclusion, combination chemotherapy is associated with clinical improvement in a substantial number of patients with advanced nonsmall cell lung cancer of poor performance status.