title: Influence of histological type, smoking history and chemotherapy on survival after first-line therapy in patients with advanced non-small cell lung cancer.
abstract: The usual primary endpoint in clinical trials for first-line chemotherapy in advanced non-small cell lung cancer is overall survival. Second-line chemotherapy can also prolong overall survival. Non-smoking history has been associated with a treatment effect for epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) versus placebo for overall survival. We performed a retrospective analysis to identify prognostic factors for progression-free survival and overall survival in patients with advanced non-small cell lung cancer treated with first-line carboplatin/paclitaxel, and to examine the effect of second-line therapy on progression-free survival and overall survival. Ninety-eight patients (median age 61 years, 35 female, 74 adenocarcinoma, 68 smokers, 56 performance status 0) fulfilled our criteria, of which 75 patients (78%) received more than second-line therapy (docetaxel [54%] gefitinib [48%] erlotinib [4%]). For overall survival, smoking history and histology were significant prognostic factors. The 2-year overall survival rates were as follows: smokers, 17%; non-smokers, 52%, P < 0.0001; adenocarcinoma, 40%; other 15%, P = 0.0017. Multivariate analysis in patients who received second-line therapy showed treatment with EGFR-TKI was an independent predictor of overall survival. Smoking history and adenocarcinoma histology were prognostic factors for an improved outcome with carboplatin/paclitaxel in patients with non-small cell lung cancer. Our study results suggest that the use of EGFR-TKI after first-line treatment may be associated with an improvement in overall survival.
authors.affiliation: Thoracic Oncology Division, Shizuoka Cancer center, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Itaya
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamaoto
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.forename: Masako
authors.initials: M
authors.lastname: Ebisawa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.forename: Gyo
authors.initials: G
authors.lastname: Asai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Endo
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification / Q000188:drug therapy* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome