Patients with low Karnofsky performance status and advanced non-small cell lung cancer are improved with chemotherapy: a retrospective analysis of a phase III randomised trial

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

	Abstract

To determine the potential benefit of conventional cisplatin-based chemotherapy on patients with advanced non-small cell lung cancer (NSCLC) and poor performance status (PS), defined as 60–70 on the Karnofsky scale.

Retrospective analysis of a randomised trial performed in advanced NSCLC where 485 patients received three courses of GIP (gemcitabine+ifosfamide+cisplatin) induction chemotherapy. For the purpose of the present study, poor PS was defined as 60-70 on the Karnofsky scale.

80% of the patients had good PS (Karnofsky 80-100) and 20% poor PS. Response rates were 38 and 28% respectively (p=0.06). 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 (p=0.05). PS improved more quickly in the responders. Survival of patients with poor PS was significantly worse but survival of responders was similar, irrespectively of the initial poor or good PS. Although non fatal toxicity was almost similar, there were more toxic deaths (including vascular and cardiac fatalities) in the poor PS patients (9.2% versus 2.1%; p=0.002).

Combination chemotherapy is associated with clinical improvement in a substantial number of patients with advanced NSCLC of poor PS.