title: Early response to platinum-based first-line chemotherapy in non-small cell lung cancer may predict survival.
abstract: BACKGROUND
  Response rates in the palliative treatment of non-small cell lung cancer, with combination platinum-based chemotherapy, vary from 20% to 40%, leaving a large number with either stable or progressive disease. We examined radiographic response after two courses of platinum-based induction chemotherapy to see whether this is an early predictor of outcome.
  
  
  METHODS
  In this retrospective study, 320 patients with stage III/IV NSCLC were identified who received 4 or more courses of first-line platinum-based chemotherapy and attained partial response (PR) or stable disease (SD).
  
  
  RESULTS
  After two courses, 115 patients attained PR and 205 SD. Cox regression analysis shows that response after two courses of chemotherapy remains an independent significant prognostic factor for survival. The 2-year survival for patients attaining PR after two courses (n = 115) was 23% compared with 11% (n = 205) for those with SD (p = 0.002). Patients who achieve an objective response after two courses also have a better symptomatic response (p = 0.003) and it was significantly longer (p = 0.04). Of the 205 with SD, 51 attained PR with four courses, whereas 154 (48%) remained with SD; there was no difference in survival outcome of these two groups.
  
  
  CONCLUSIONS
  These data suggest that NSCLC patients who only have SD after two cycles of first-line chemotherapy have poorer survival outcome and less symptomatic benefit than those in PR. Trials looking at change in management at this point are warranted.
authors.affiliation: Lung Unit, Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Sirohi
authors.forename: Sue
authors.initials: S
authors.lastname: Ashley
authors.forename: Alison
authors.initials: A
authors.lastname: Norton
authors.forename: Sanjay
authors.initials: S
authors.lastname: Popat
authors.forename: Sarah
authors.initials: S
authors.lastname: Hughes
authors.forename: Panagiotous
authors.initials: P
authors.lastname: Papadopoulos
authors.forename: Kathryn
authors.initials: K
authors.lastname: Priest
authors.forename: Mary
authors.initials: M
authors.lastname: O'Brien
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018287:Carcinoma, Large Cell / Q000188:drug therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds