The role of chemotherapy in patients with small cell lung cancer and poor performance status

Figures & data

Figure 1. The flowchart of patients evaluated and enrolled on the small cell lung cancer poor performance status observational study.

Table 1. Demographic details and baseline disease characteristics of the patients with small cell lung carcinoma who presented with poor performance status.

Demographic characteristic	Patients number (%) N = 234
Age in years - median (range)	60 (22–89)
Male sex	194 (82.9)
Smoking history
Never-smoker	23 (9.8)
Former smoker, quit >3 months ago	53 (22.6)
Current active smoker, or quit =/<3 months ago	106 (45.3)
Comorbidities
None	129 (55.1)
Present	105 (44.8)
Presenting symptoms
Shortness of breath	149 (63.7)
Cough	146 (62.4)
Chest pain	116 (49.6)
Anorexia/weight loss	75 (32.1)
Baseline laboratory values - median (range)
Hemoglobin in g/dl	12.1 (6.5–16)
Calculated^a glomerular filtration rate in cc/min	60.44 (14–170)
Sodium in mmol/L	132 (104–143)
Lactate dehydrogenase in U/L	413.5 (155–4018)
Stage of the disease-no. (%)
Limited	24 (10.3)
Extensive	210 (89.7)
Metastatic site-no. (%)
Non-metastatic	26 (11.1)
Pleural effusion/pleural nodules/pericardial effusion	49 (20.9)
Contralateral lung nodules	10 (4.3)
Distant metastases^b	89 (38)
Multiple (>1 metastatic site)	60 (25.6)
Superior vena cava obstruction (at presentation)	83 (35.5)
Presence of brain metastases at presentation^b	24 (10.3)

^a Chronic obstructive pulmonary disease 21 (9%), hypertension 19 (8%), diabetes 13 (6%), cardiac 13 (6%), stroke 1 (0.4%), rheumatoid arthritis 1 (0.4%), schizophrenia 1 (0.4%), multiple (>1) 36 (15%). Glomerular filtration rate (GFR) was calculated by the Cockcroft–Gault formula.

^b Brain imaging was done at baseline in only 65 (28%) patients (MRI brain in 52 and CT brain in 13). Bones 32 (14%), liver 26 (11%), adrenal 14 (6%), brain 10 (4%), non-regional lymph nodes 6 (3%), spleen 1 (0.4%).

Table 2. Therapy details of small cell lung cancer patients with poor performance status, i.e. ECOG PS 3 or 4.

Treatment details	Patients-number (%) N = 234
Initial therapy-no. (%)
1) Best supportive care	49 (20.9)
2) Single agent chemotherapy	93 (39.7)
• Carboplatin AUC^a 2 IV^b for 1–3 doses, at daily to weekly intervals	30
• Cisplatin flat dose (20 mg daily) or 33 mg/m^2 IV^b daily for three doses	2
• Carboplatin AUC^a 5 IV^b	28
• Carboplatin AUC^a 2 IV^b, followed by attenuated dose of carboplatin/cisplatin with etoposide IV^b	24
• Oral etoposide	7
• Other^c	2
3) Combination chemotherapy-attenuated dose	61 (26.1)
• Cisplatin/etoposide	16
• Carboplatin/etoposide	43
• Carboplatin/pemetrexed	1
• Carboplatin/paclitaxel	1
4) Standard full dose chemotherapy (platinum with etoposide)	31 (13.2)
Delivery of full dose chemotherapy-no. (%)
• No	128 (54.7)
• Yes	105 (44.9)
Upfront	31
After initial attenuated chemotherapy	74
• Unknown	1 (0.4)
Reason for non-receipt of full dose chemotherapy (n = 128)
• Patient or physician decided on no systemic therapy at presentation	45
• Patient went to local place and continued initial attenuated regimen, or stopped therapy locally	30
• Patient died of disease before chemotherapy could be administered	15
• Performance status did not improve with attenuated chemotherapy	18
• Toxicity of attenuated chemotherapy regimen	10
• Organ dysfunction or advanced age	5
• Unknown	5

^a AUC, area under the curve, calculated by Calvert’s formula.

^b IV, intravenous.

^c Other single agent systemic therapy regimens: 1-erlotinib, 1-cyclophosphamide 1 g IV.

Table 3. The demographics and baseline disease characteristics of the patients with small cell lung cancer and poor performance status, grouped according to the initial therapy they received-best supportive care, attenuated chemotherapy, and standard full-dose chemotherapy.

Characteristics	Best supportive care (n = 49)	Attenuated chemotherapy (n = 154)	Standard full dose chemotherapy (n = 31)	P value
Age-mean in years	63	60	54	<0.001
PS 4 patients (%)	15 (30.6)	29 (18.8)	5 (16.1)	0.164
Multiple comorbidities (%)	7 (14.3)	27 (17.5)	2 (6.5)	0.288
GFR-mean, calculated by Cockcroft–Gault formula, in cc/min	50.98 (18.12)	63.51 (22.91)	73.18 (21.24)	0.001
LDH-mean in U/L	655.65 (895.52)	545.07 (445.49)	558.73 (299.34)	0.645
Weight-mean in kg	49.48 (8.64)	52.45 (11.51)	57.15 (8.66)	0.023

Figure 2. The overall survival (OS) for patients with small cell lung carcinoma and poor performance status (PS 3 or 4), who received any chemotherapy versus best supportive care (BSC). The median OS for the patients who received any chemotherapy was significantly longer at 6 months (95% CI, 4.8–7.2) compared to 1 month (95% CI, 0.4–1.6) in patients who were managed with BSC, p < 0.001; hazard ratio, 0.39 (95% CI, 0.27–0.56).