IASLC: Third-Generation Chemotherapeutics Improve Survival in Real-World Palliative Care

SEOUL, South Korea, Sept. 5 -- Third-generation chemotherapy agents appear to have modestly improved population-level survival among advanced stage non-small cell lung cancer patients.

In Norway, introduction of one such drug--vinorelbine (Navelbine)--for palliative care significantly improved median survival by 27 days, reported Christian von Plessen, M.D., of the University of Bergen, and colleagues here at the International Association for the Study of Lung Cancer world conference.

The findings confirm the benefit seen in highly selective and "artificial" clinical trial environments, commented Philip Bonomi, M.D., of Rush University Medical Center in Chicago, who was a discussant for the study.

Vinorelbine was the only third-generation chemotherapy agent, a group that also includes gemcitabine (Gemzar) and docetaxel (Taxotere), used for this patient population, typically in combination with carboplatin (Paraplatin).

Because clinical trials have not shown a difference between the third-generation cytoxics, vinorelbine was used as an indicator drug for chemotherapy utilization.

The researchers examined 13,757 cases of advanced-stage non-small-cell lung cancer in the Cancer Registry of Norway that occurred from 1994 to 2005. These were divided into two periods: 1994 to 1998, before vinorelbine's introduction, and 2000 to 2005 once the drug was widely available for use.

The majority of patients (61.2%) had metastatic disease, 27.5% had regionally advanced cancer, and the remainder had unspecified metastatic status.

The mean age was 67.5, and 65.1% of the patients were men. The type of disease was most often adenomacarcinoma (38.0%) followed by squamous cell carcinoma (28.5%), nonspecified type (26.5%), and large cell carcinoma (7.1%).

Median overall survival was significantly better during the period with the third-generation chemotherapy agent than that without it (hazard ratio 0.93, 95% confidence interval 0.88 to 0.99). One-year survival rates increased by 4%.

The researchers also looked at survival according to use of vinorelbine across the country and over time. To do this, they used sales data from Norway's National Institute of Public Health to calculate population-based utilization rates for each county in the nation.

Again, greater vinorelbine use was associated with improvement in survival. For every 100 mg more vinorelbine used in a county per 1,000 citizens, survival odds improved 16% (HR 0.84, 95% CI 0.73 to 0.98).

Drugs not commonly used for disease palliation in Norway appeared to have little impact on survival over the study periods.

Gemcitabine utilization rates for each county were not significantly associated with survival odds (HR 0.98, P=0.94 to 1.10). Cisplatin (Platinol) use rates per county (HR 0.81, 95% CI 0.58 to 1.13) and carboplatin utilization rates per county likewise had no effect over the study periods on survival odds.

Utilization rates for vinorelbine varied substantially across counties, although the rates appeared to be converging over time, Dr. von Plessen noted.

An even wider range in use rates would be expected for larger countries, such as the United States, added Trond-Erik Strand, M.D., of the Cancer Registry of Norway in Oslo, who was another researcher on the study.

"It shouldn't matter where you live," Dr. von Plessen said, adding that these differences "should be minimized to achieve similar positive survival benefits for all patients."