Survival benefit and potential markers of chemotherapy for elderly and poor performance status patients with advanced non-small cell lung cancer: Results from the Japanese Joint Committee of lung cancer registry database

Abstract

Introduction

Data on chemotherapy for elderly, poor performance status (PS) non-small cell lung cancer (NSCLC) are clinically important but insufficient due to their exclusion from most interventional studies. This study aims to explore actual treatment status and prognosis, as well as factors predicting patients who may benefit from chemotherapy.

Materials and Methods

Advanced NSCLC patients aged ≥75 years with PS 2–3 and no/unknown driver mutations were included. In each of PS2 and PS3 cohorts, we compared the overall survival (OS) of the chemotherapy and Best Supportive Care (BSC) group after adjusting by inverse probability weighting (IPW) method, and analyzed prognostic factors using the COX proportional hazards model. We defined the patients with body weight loss ≥5 % within 6 months as cancer cachexia in this study.

Results

This study included 282 patients (Chemotherapy;107, BSC;175) in PS2 cohort and 230 patients (Chemotherapy;39, BSC;191) in PS3 cohort. In both PS2 and PS3 cohorts, IPW-adjusted OS was significantly longer in the chemotherapy group than in the BSC group (HR 0.42 [95 % CI 0.32–0.55] and 0.56 [95 % CI 0.41–0.75], p < 0.001 and 0.003, respectively). Multivariate analysis showed that cancer cachexia and stage IV were significantly associated with OS in PS2 cohort. For patients with cancer cachexia in PS3 cohort, chemotherapy did not prolong OS (HR 0.81 [95 % CI 0.45–1.45], p = 0.530).

Conclusion

Chemotherapy might provide a survival benefit even for elderly, poor PS NSCLC patients. In vulnerable PS 3 patients, cancer cachexia may be useful in predicting patients who may benefit from chemotherapy.