title: Influence of cisplatin-use, age, performance status and duration of chemotherapy on symptom control in advanced non-small cell lung cancer: detailed symptom analysis of a randomised study comparing cisplatin-vindesine to gemcitabine.
abstract: BACKGROUND
  We previously reported that treatment of patients with symptomatic advanced non-small cell lung cancer with single agent Gemcitabine (GEM) resulted in a superior clinical-benefit response rate (RR) compared to cisplatin-based combination chemotherapy. We now report the detailed individual symptom control analysis, and the influence of cisplatin-use, age, performance status (PS) and duration of treatment.
  
  
  METHODS
  Patients received either GEM (1000 mg/m(2), days 1, 8 and 15) or cisplatin (100 mg/m(2), day 1) plus Vindesine (3 mg/m(2), days 1 and 15) (PV), both every 4 weeks. Scores of 9 symptoms were listed weekly by the patient on visual analogue scales. Improvement of a symptom was defined as 2 consecutive cycles of improvement over baseline.
  
  
  RESULTS
  Baseline symptoms in the 169 patients were well balanced between the 2 arms (84 GEM, 85 PV). Both patients with objective response and disease stabilisation had clearly better symptom control than those with disease progression. Symptom control in both arms was similar for 'disease-specific' symptoms such as cough, dyspnea, pain or haemoptysis. Compared to PV, a significantly larger number of GEM-patients had better scores for 'constitutional' items such as anorexia (P=0.007), ability to carry on with daily activities (P=0.04) and overall impression of quality-of-life (P=0.008). Symptom control was very similar in younger (<65 years) versus older (>/=65 years) patients, and only slightly better in those with a Karnofsky PS >/=80% compared to those <80%. Most of the symptom improvement occurred in the first 3 cycles, with some further symptom improvement in the following cycles in the GEM-arm only.
  
  
  CONCLUSIONS
  Both GEM and PV yield a symptom control rate much higher than expected by the objective tumour RR. GEM is equally effective in controlling 'disease-specific' symptoms, but superior in controlling 'constitutional' symptoms. Most of the symptom control was achieved during the first 3 cycles of treatment, with some further improvement thereafter in the GEM-arm only.
authors.affiliation: Respiratory Oncology Unit (Department of Pulmonology), University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. johan.vansteenkiste@uz.kuleuven.ac.be
authors.forename: Johan
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: Jean
authors.initials: J
authors.lastname: Vandebroek
authors.forename: Kris
authors.initials: K
authors.lastname: Nackaerts
authors.forename: Christophe
authors.initials: C
authors.lastname: Dooms
authors.forename: Dany
authors.initials: D
authors.lastname: Galdermans
authors.forename: Lionel
authors.initials: L
authors.lastname: Bosquée
authors.forename: Alain
authors.initials: A
authors.lastname: Delobbe
authors.forename: Koen
authors.initials: K
authors.lastname: Deschepper
authors.forename: Wim
authors.initials: W
authors.lastname: Van Kerckhoven
authors.forename: Kurt
authors.initials: K
authors.lastname: Vandeurzen
authors.forename: Rene
authors.initials: R
authors.lastname: Deman
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: D'Odemont
authors.forename: Luc
authors.initials: L
authors.lastname: Siemons
authors.forename: Paul
authors.initials: P
authors.lastname: Van den Brande
authors.forename: Nancy
authors.initials: N
authors.lastname: Dams
mesh_terms: D000367:Age Factors; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018450:Disease Progression; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D014751:Vindesine / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D002945:Cisplatin; D014751:Vindesine; D000093542:Gemcitabine