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Published in: Medical Oncology 1/2012

01-03-2012 | Original Paper

Significance of pretreatment comorbidities in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy or epidermal growth factor receptor-tyrosine kinase inhibitor

Authors: Kaoru Irisa, Katsuhiro Masago, Yosuke Togashi, Shiro Fujita, Yukimasa Hatachi, Akiko Fukuhara, Yuichi Sakamori, Yung Hak Kim, Tadashi Mio, Michiaki Mishima

Published in: Medical Oncology | Issue 1/2012

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Abstract

A standard, valid assay of comorbidities for elderly patients with advanced non-small-cell lung cancer (NSCLC) who have received antitumor therapy is needed to provide useful prognostic information. The aim of this study was to analyze prognostic factors and validate classic Charlson comorbidity index (CCI) and comorbidity scores in elderly patients with advanced NSCLC treated with chemotherapy or epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). A retrospective analysis was conducted on 162 patients with advanced NSCLC over 70 years old at diagnosis, who were treated with cytotoxic chemotherapy or with EGFR-TKIs between April 2003 and April 2009 at Kyoto University Hospital. Collected data included clinical assessments, treatments, toxicities, and outcomes. Survival was estimated using the Kaplan–Meier method. Prognostic factors were evaluated with log-rank and Cox regression tests. Based on multivariate analysis, unspecified NSCLC histology [Hazard ratio (HR), 1.631; 95% Confidence interval (CI), 1.184–2.263; P = 0.0016], more than 3 comorbidities (HR, 1.317; 95% CI, 1.020–2.675; P = 0.0350), and a CCI of more than 3 (HR, 1.321; 95% CI, 1.031–1.664; P = 0.0285) were significant independent negative prognostic factors for survival. Our results indicate that CCI and the number of comorbidities are independent predictors of survival in elderly patients undergoing systemic chemotherapy including EGFR-TKIs for advanced NSCLC. These factors should be taken into consideration in the pretreatment assessment as important factors predicting survival outcome.
Literature
1.
2.
go back to reference Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, Ramalingam SS. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.PubMedCrossRef Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, Ramalingam SS. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.PubMedCrossRef
3.
go back to reference The Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 1999;91:66–72.CrossRef The Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 1999;91:66–72.CrossRef
4.
go back to reference Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, Barbera S, Ferrau F, Piazza E, Rosetti F, Clerici M, Bertetto O, Robbiati SF, Frontini L, Sacco C, Castiglione F, Favaretto A, Novello S, Migliorino MR, Gasparini G, Galetta D, Iaffaioli RV, Gebbia V. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: The multicenter italian lung cancer in the elderly study (miles) phase III randomized trial. J Natl Cancer Inst. 2003;95:362–72.PubMedCrossRef Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, Barbera S, Ferrau F, Piazza E, Rosetti F, Clerici M, Bertetto O, Robbiati SF, Frontini L, Sacco C, Castiglione F, Favaretto A, Novello S, Migliorino MR, Gasparini G, Galetta D, Iaffaioli RV, Gebbia V. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: The multicenter italian lung cancer in the elderly study (miles) phase III randomized trial. J Natl Cancer Inst. 2003;95:362–72.PubMedCrossRef
5.
go back to reference Kudoh S, Takeda K, Nakagawa K, Takada M, Katakami N, Matsui K, Shinkai T, Sawa T, Goto I, Semba H, Seto T, Ando M, Satoh T, Yoshimura N, Negoro S, Fukuoka M. Phase iii study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the west japan thoracic oncology group trial (WGTOG 9904). J Clin Oncol. 2006;24:3657–63.PubMedCrossRef Kudoh S, Takeda K, Nakagawa K, Takada M, Katakami N, Matsui K, Shinkai T, Sawa T, Goto I, Semba H, Seto T, Ando M, Satoh T, Yoshimura N, Negoro S, Fukuoka M. Phase iii study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the west japan thoracic oncology group trial (WGTOG 9904). J Clin Oncol. 2006;24:3657–63.PubMedCrossRef
6.
go back to reference Firat S, Byhardt RW, Gore E. The effects of comorbidity and age on rtog study enrollment in stage iii non-small cell lung cancer patients who are eligible for rtog studies. Int J Radiat Oncol Biol Phys. 2010;78:1394–9.CrossRef Firat S, Byhardt RW, Gore E. The effects of comorbidity and age on rtog study enrollment in stage iii non-small cell lung cancer patients who are eligible for rtog studies. Int J Radiat Oncol Biol Phys. 2010;78:1394–9.CrossRef
7.
go back to reference Jackman DM, Yeap BY, Lindeman NI, Fidias P, Rabin MS, Temel J, Skarin AT, Meyerson M, Holmes AJ, Borras AM, Freidlin B, Ostler PA, Lucca J, Lynch TJ, Johnson BE, Janne PA. Phase ii clinical trial of chemotherapy-naive patients ≥ 70 years of age treated with erlotinib for advanced non-small-cell lung cancer. J Clin Oncol. 2007;25:760–6.PubMedCrossRef Jackman DM, Yeap BY, Lindeman NI, Fidias P, Rabin MS, Temel J, Skarin AT, Meyerson M, Holmes AJ, Borras AM, Freidlin B, Ostler PA, Lucca J, Lynch TJ, Johnson BE, Janne PA. Phase ii clinical trial of chemotherapy-naive patients ≥ 70 years of age treated with erlotinib for advanced non-small-cell lung cancer. J Clin Oncol. 2007;25:760–6.PubMedCrossRef
8.
go back to reference Crino L, Cappuzzo F, Zatloukal P, Reck M, Pesek M, Thompson JC, Ford HE, Hirsch FR, Varella-Garcia M, Ghiorghiu S, Duffield EL, Armour AA, Speake G, Cullen M. Gefitinib versus vinorelbine in chemotherapy-naive elderly patients with advanced non-small-cell lung cancer (invite): a randomized, phase ii study. J Clin Oncol. 2008;26:4253–60.PubMedCrossRef Crino L, Cappuzzo F, Zatloukal P, Reck M, Pesek M, Thompson JC, Ford HE, Hirsch FR, Varella-Garcia M, Ghiorghiu S, Duffield EL, Armour AA, Speake G, Cullen M. Gefitinib versus vinorelbine in chemotherapy-naive elderly patients with advanced non-small-cell lung cancer (invite): a randomized, phase ii study. J Clin Oncol. 2008;26:4253–60.PubMedCrossRef
9.
go back to reference Wheatley-Price P, Ding K, Seymour L, Clark GM, Shepherd FA. Erlotinib for advanced non-small-cell lung cancer in the elderly.: An analysis of the national cancer institute of canada clinical trials group study br.21. J Clin Oncol. 2008;26:2350–7.PubMedCrossRef Wheatley-Price P, Ding K, Seymour L, Clark GM, Shepherd FA. Erlotinib for advanced non-small-cell lung cancer in the elderly.: An analysis of the national cancer institute of canada clinical trials group study br.21. J Clin Oncol. 2008;26:2350–7.PubMedCrossRef
10.
go back to reference Ramalingam SS, Dahlberg SE, Langer CJ, Gray R, Belani CP, Brahmer JR, Sandler AB, Schiller JH, Johnson DH. Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: analysis of eastern cooperative oncology group trial 4599. J Clin Oncol. 2008;26:60–5.PubMedCrossRef Ramalingam SS, Dahlberg SE, Langer CJ, Gray R, Belani CP, Brahmer JR, Sandler AB, Schiller JH, Johnson DH. Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: analysis of eastern cooperative oncology group trial 4599. J Clin Oncol. 2008;26:60–5.PubMedCrossRef
11.
go back to reference Firat S, Byhardt RW, Gore E. Comorbidity and karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four rtog studies. Radiation therapy oncology group. Int J Radiat Oncol Biol Phys. 2002;54:357–64.PubMedCrossRef Firat S, Byhardt RW, Gore E. Comorbidity and karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four rtog studies. Radiation therapy oncology group. Int J Radiat Oncol Biol Phys. 2002;54:357–64.PubMedCrossRef
12.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRef
13.
go back to reference Colinet B, Jacot W, Bertrand D, Lacombe S, Bozonnat MC, Daures JP, Pujol JL. A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: Description and comparison with the charlson’s index. Br J Cancer. 2005;93:1098–105.PubMedCrossRef Colinet B, Jacot W, Bertrand D, Lacombe S, Bozonnat MC, Daures JP, Pujol JL. A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: Description and comparison with the charlson’s index. Br J Cancer. 2005;93:1098–105.PubMedCrossRef
14.
go back to reference Li J, Chen P, Dai CH, Li XQ, Bao QL. Prognostic factors in elderly patients with advanced non-small cell lung cancer treated with chemotherapy. Oncology. 2009;76:355–62.PubMedCrossRef Li J, Chen P, Dai CH, Li XQ, Bao QL. Prognostic factors in elderly patients with advanced non-small cell lung cancer treated with chemotherapy. Oncology. 2009;76:355–62.PubMedCrossRef
15.
go back to reference Yancik R, Ganz PA, Varricchio CG, Conley B. Perspectives on comorbidity and cancer in older patients: Approaches to expand the knowledge base. J Clin Oncol. 2001;19:1147–51.PubMed Yancik R, Ganz PA, Varricchio CG, Conley B. Perspectives on comorbidity and cancer in older patients: Approaches to expand the knowledge base. J Clin Oncol. 2001;19:1147–51.PubMed
16.
go back to reference Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised recist guideline (version 1.1). Eur J Cancer. 2009;45:228–47.PubMedCrossRef Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised recist guideline (version 1.1). Eur J Cancer. 2009;45:228–47.PubMedCrossRef
17.
go back to reference Singh B, Bhaya M, Stern J, Roland JT, Zimbler M, Rosenfeld RM, Har-El G, Lucente FE. Validation of the charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope. 1997;107:1469–75.PubMedCrossRef Singh B, Bhaya M, Stern J, Roland JT, Zimbler M, Rosenfeld RM, Har-El G, Lucente FE. Validation of the charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope. 1997;107:1469–75.PubMedCrossRef
18.
go back to reference Singh B, Bhaya M, Zimbler M, Stern J, Roland JT, Rosenfeld RM, Har-El G, Lucente FE. Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma. Head Neck. 1998;20:1–7.PubMedCrossRef Singh B, Bhaya M, Zimbler M, Stern J, Roland JT, Rosenfeld RM, Har-El G, Lucente FE. Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma. Head Neck. 1998;20:1–7.PubMedCrossRef
19.
go back to reference Lubke T, Monig SP, Schneider PM, Holscher AH, Bollschweiler E. Does charlson-comorbidity index correlate with short-term outcome in patients with gastric cancer? Zentralbl Chir. 2003;128:970–6.PubMedCrossRef Lubke T, Monig SP, Schneider PM, Holscher AH, Bollschweiler E. Does charlson-comorbidity index correlate with short-term outcome in patients with gastric cancer? Zentralbl Chir. 2003;128:970–6.PubMedCrossRef
20.
go back to reference Miller DC, Taub DA, Dunn RL, Montie JE, Wei JT. The impact of co-morbid disease on cancer control and survival following radical cystectomy. J Urol. 2003;169:105–9.PubMedCrossRef Miller DC, Taub DA, Dunn RL, Montie JE, Wei JT. The impact of co-morbid disease on cancer control and survival following radical cystectomy. J Urol. 2003;169:105–9.PubMedCrossRef
21.
go back to reference Gettman MT, Boelter CW, Cheville JC, Zincke H, Bryant SC, Blute ML. Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol. 2003;169:1282–6.PubMedCrossRef Gettman MT, Boelter CW, Cheville JC, Zincke H, Bryant SC, Blute ML. Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol. 2003;169:1282–6.PubMedCrossRef
22.
go back to reference Froehner M, Koch R, Litz R, Heller A, Oehlschlaeger S, Wirth MP. Comparison of the american society of anesthesiologists physical status classification with the charlson score as predictors of survival after radical prostatectomy. Urology. 2003;62:698–701.PubMedCrossRef Froehner M, Koch R, Litz R, Heller A, Oehlschlaeger S, Wirth MP. Comparison of the american society of anesthesiologists physical status classification with the charlson score as predictors of survival after radical prostatectomy. Urology. 2003;62:698–701.PubMedCrossRef
23.
go back to reference Ather MH, Nazim SM. Impact of charlson’s comorbidity index on overall survival following tumor nephrectomy for renal cell carcinoma. Int Urol Nephrol. 2009;42:299–303.PubMedCrossRef Ather MH, Nazim SM. Impact of charlson’s comorbidity index on overall survival following tumor nephrectomy for renal cell carcinoma. Int Urol Nephrol. 2009;42:299–303.PubMedCrossRef
24.
go back to reference Birim O, Zuydendorp HM, Maat AP, Kappetein AP, Eijkemans MJ, Bogers AJ. Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg. 2003;76:1796–801.PubMedCrossRef Birim O, Zuydendorp HM, Maat AP, Kappetein AP, Eijkemans MJ, Bogers AJ. Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg. 2003;76:1796–801.PubMedCrossRef
25.
go back to reference Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16:1582–7.PubMed Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16:1582–7.PubMed
26.
go back to reference Feliu J, Lopez Gomez L, Madronal C, Espinosa E, Espinosa J, Giron CG, Martinez B, Castro J, De la Gandara I, Baron MG. Gemcitabine plus vinorelbine in nonsmall cell lung carcinoma patients age 70 years or older or patients who cannot receive cisplatin. Oncopaz cooperative group. Cancer. 1999;86:1463–9.PubMedCrossRef Feliu J, Lopez Gomez L, Madronal C, Espinosa E, Espinosa J, Giron CG, Martinez B, Castro J, De la Gandara I, Baron MG. Gemcitabine plus vinorelbine in nonsmall cell lung carcinoma patients age 70 years or older or patients who cannot receive cisplatin. Oncopaz cooperative group. Cancer. 1999;86:1463–9.PubMedCrossRef
27.
go back to reference Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, Cigolari S, Rosetti F, Piazza E, Robbiati SF, Bertetto O, Novello S, Migliorino MR, Favaretto A, Spatafora M, Ferrau F, Frontini L, Bearz A, Repetto L, Gridelli C, Barletta E, Barzelloni ML, Iaffaioli RV, De Maio E, Di Maio M, De Feo G, Sigoriello G, Chiodini P, Cioffi A, Guardasole V, Angelini V, Rossi A, Bilancia D, Germano D, Lamberti A, Pontillo V, Brancaccio L, Renda F, Romano F, Esani G, Gambaro A, Vinante O, Azzarello G, Clerici M, Bollina R, Belloni P, Sannicolo M, Ciuffreda L, Parello G, Cabiddu M, Sacco C, Sibau A, Porcile G, Castiglione F, Ostellino O, Monfardini S, Stefani M, Scagliotti G, Selvaggi G, De Marinis F, Martelli O, Gasparini G, Morabito A, Gattuso D, Colucci G, Galetta D, Giotta F, Gebbia V, Borsellino N, Testa A, Malaponte E, Capuano MA, Angiolillo M, Sollitto F, Tirelli U, Spazzapan S, Adamo V, Altavilla G, Scimone A, Hopps MR, Tartamella F, Ianniello GP, Tinessa V, Failla G, Bordonaro R, Gebbia N, Valerio MR, D’Aprile M, Veltri E, Tonato M, Darwish S, Romito S, Carrozza F, Barni S, Ardizzoia A, Corradini GM, Pavia G, Belli M, Colantuoni G, Galligioni E, Caffo O, Labianca R, Quadri A, Cortesi E, D’Auria G, Fava S, Calcagno A, Luporini G, Locatelli MC, Di Costanzo F, Gasperoni S, Isa L, Candido P, Gaion F, Palazzolo G, Nettis G, Annamaria A, Rinaldi M, Lopez M, Felletti R, Di Negro GB, Rossi N, Calandriello A, Maiorino L, Mattioli R, Celano A, Schiavon S, Illiano A, Raucci CA, Caruso M, Foa P, Tonini G, Curcio C, Cazzaniga M. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: A prognostic analysis of the multicenter italian lung cancer in the elderly study. J Clin Oncol. 2005;23:6865–72.PubMedCrossRef Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, Cigolari S, Rosetti F, Piazza E, Robbiati SF, Bertetto O, Novello S, Migliorino MR, Favaretto A, Spatafora M, Ferrau F, Frontini L, Bearz A, Repetto L, Gridelli C, Barletta E, Barzelloni ML, Iaffaioli RV, De Maio E, Di Maio M, De Feo G, Sigoriello G, Chiodini P, Cioffi A, Guardasole V, Angelini V, Rossi A, Bilancia D, Germano D, Lamberti A, Pontillo V, Brancaccio L, Renda F, Romano F, Esani G, Gambaro A, Vinante O, Azzarello G, Clerici M, Bollina R, Belloni P, Sannicolo M, Ciuffreda L, Parello G, Cabiddu M, Sacco C, Sibau A, Porcile G, Castiglione F, Ostellino O, Monfardini S, Stefani M, Scagliotti G, Selvaggi G, De Marinis F, Martelli O, Gasparini G, Morabito A, Gattuso D, Colucci G, Galetta D, Giotta F, Gebbia V, Borsellino N, Testa A, Malaponte E, Capuano MA, Angiolillo M, Sollitto F, Tirelli U, Spazzapan S, Adamo V, Altavilla G, Scimone A, Hopps MR, Tartamella F, Ianniello GP, Tinessa V, Failla G, Bordonaro R, Gebbia N, Valerio MR, D’Aprile M, Veltri E, Tonato M, Darwish S, Romito S, Carrozza F, Barni S, Ardizzoia A, Corradini GM, Pavia G, Belli M, Colantuoni G, Galligioni E, Caffo O, Labianca R, Quadri A, Cortesi E, D’Auria G, Fava S, Calcagno A, Luporini G, Locatelli MC, Di Costanzo F, Gasperoni S, Isa L, Candido P, Gaion F, Palazzolo G, Nettis G, Annamaria A, Rinaldi M, Lopez M, Felletti R, Di Negro GB, Rossi N, Calandriello A, Maiorino L, Mattioli R, Celano A, Schiavon S, Illiano A, Raucci CA, Caruso M, Foa P, Tonini G, Curcio C, Cazzaniga M. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: A prognostic analysis of the multicenter italian lung cancer in the elderly study. J Clin Oncol. 2005;23:6865–72.PubMedCrossRef
Metadata
Title
Significance of pretreatment comorbidities in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy or epidermal growth factor receptor-tyrosine kinase inhibitor
Authors
Kaoru Irisa
Katsuhiro Masago
Yosuke Togashi
Shiro Fujita
Yukimasa Hatachi
Akiko Fukuhara
Yuichi Sakamori
Yung Hak Kim
Tadashi Mio
Michiaki Mishima
Publication date
01-03-2012
Publisher
Springer US
Published in
Medical Oncology / Issue 1/2012
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI
https://doi.org/10.1007/s12032-010-9764-0

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