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Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration data. J Clin Oncol 2015 Feb 20;33(6):567-74 PMID: 25422491 PMCID: PMC4322259

Pubmed ID

25422491

Abstract

PURPOSE: The optimal chemotherapy regimen to use with radiotherapy in stage III non-small-cell lung cancer is unknown. Here, we compare the outcome of patents treated within the Veterans Health Administration with either etoposide-cisplatin (EP) or carboplatin-paclitaxel (CP).

METHODS: We identified patients treated with EP and CP with concurrent radiotherapy from 2001 to 2010. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods and an instrumental variables analysis. Comorbidities and treatment complications were identified through administrative data.

RESULTS: A total of 1,842 patients were included; EP was used in 27% (n = 499). Treatment with EP was not associated with a survival advantage in a Cox proportional hazards model (hazard ratio [HR], 0.97; 95% CI, 0.85 to 1.10), a propensity score matched cohort (HR, 1.07; 95% CI, 0.91 to 1.24), or a propensity score adjusted model (HR, 0.97; 95% CI, 0.85 to 1.10). In an instrumental variables analysis, there was no survival advantage for patients treated in centers where EP was used more than 50% of the time as compared with centers where EP was used in less than 10% of the patients (HR, 1.07; 95% CI, 0.90 to 1.26). Patients treated with EP, compared with patients treated with CP, had more hospitalizations (2.4 v 1.7 hospitalizations, respectively; P < .001), outpatient visits (17.6 v 12.6 visits, respectively; P < .001), infectious complications (47.3% v 39.4%, respectively; P = .0022), acute kidney disease/dehydration (30.5% v 21.2%, respectively; P < .001), and mucositis/esophagitis (18.6% v 14.4%, respectively; P = .0246).

CONCLUSION: After accounting for prognostic variables, patients treated with EP versus CP had similar overall survival, but EP was associated with increased morbidity.

Author List

Santana-Davila R, Devisetty K, Szabo A, Sparapani R, Arce-Lara C, Gore EM, Moran A, Williams CD, Kelley MJ, Whittle J

Authors

Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Rodney Sparapani PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-84923196894   46 Citations

MESH terms used to index this publication - Major topics in bold

Aged
Carboplatin
Carcinoma, Non-Small-Cell Lung
Chemoradiotherapy
Cisplatin
Cohort Studies
Etoposide
Female
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Paclitaxel
Randomized Controlled Trials as Topic
Survival Rate
Treatment Outcome
United States
United States Department of Veterans Affairs
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6