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Clinical impact of post-progression survival in patients with locally advanced non-small cell lung cancer after chemoradiotherapy Cover

Clinical impact of post-progression survival in patients with locally advanced non-small cell lung cancer after chemoradiotherapy

Radiology and Oncology
Volume 56 (2022): Issue 2 (June 2022)
By:
Open Access
|Feb 2022

Figures & Tables

Figure 1

Flow chart showing patient selection. The patients were treated with concurrent chemoradiotherapy between January 2011 and December 2018.PFS = progression-free survival
Flow chart showing patient selection. The patients were treated with concurrent chemoradiotherapy between January 2011 and December 2018.PFS = progression-free survival

Figure 2

PROGRESSION-FREE survival (PFS) and post-progression survival (PPS) in the overall population.
PROGRESSION-FREE survival (PFS) and post-progression survival (PPS) in the overall population.

Figure 3

Kaplan-Meier survival plots showing the (A) progression-free survival (PFS) and (B) overall survival (OS) of all patients.Median progression-free survival: 10.8 months; median overall survival: 31.6 months; median follow-up: 31.5 months.
Kaplan-Meier survival plots showing the (A) progression-free survival (PFS) and (B) overall survival (OS) of all patients.Median progression-free survival: 10.8 months; median overall survival: 31.6 months; median follow-up: 31.5 months.

Figure 4

Correlations between (A) overall survival (OS) and progression-free survival (PFS) and (B) between overall survival and post-progression survival (PPS).*The r values represent Spearman’s rank correlation coefficient. **The R2 values represent the linear regression.
Correlations between (A) overall survival (OS) and progression-free survival (PFS) and (B) between overall survival and post-progression survival (PPS).*The r values represent Spearman’s rank correlation coefficient. **The R2 values represent the linear regression.

Figure 5

(A) Kaplan-Meier plots showing post-progression survival (PPS) according to Glasgow prognostic score (GPS) at relapse, GPS 0–1, median = 25.7 months; GPS 2, median = 6.7 months. (B) Kaplan-Meier plots showing PPS according to liver metastases at recurrence, Without liver metastases, median = 21.3 months; With liver metastases, median = 4.2 months
(A) Kaplan-Meier plots showing post-progression survival (PPS) according to Glasgow prognostic score (GPS) at relapse, GPS 0–1, median = 25.7 months; GPS 2, median = 6.7 months. (B) Kaplan-Meier plots showing PPS according to liver metastases at recurrence, Without liver metastases, median = 21.3 months; With liver metastases, median = 4.2 months

Baseline patient characteristics

CharacteristicN = 45
Gender
        Male/female33/12
Median age at chemoradiotherapy (years)71 (41–80)
Median age at progressive disease (years)71 (42–82)
Performance Status at progressive disease
        0/1/2/3/415/22/4/4/0
Smoking history
        Yes/No36/9
Histology
        Adenocarcinoma/squamous cell carcinoma/others23/16/6
Clinical stage at diagnosis
        IIIA/IIIB/IIIC28/14/3
Driver mutation/translocation
        EGFR/ALK/ROS-1/BRAF/others/negative or unknown6/2/1/0/0/36
PD-L1 TPS
        < 1% / 1–49% / 50%/unknown6/5/8/26
Progression-free survival (months).
        < 6 / 613/32
Overall response to chemoradiotherapy
        CR/PR/SD/PD/NE0/26/15/4/0
Glasgow prognostic score (GPS)
        0–1/232/13
Administration of tyrosine kinase inhibitors
        Yes/No11/34
Administration of immune checkpoint inhibitors
        Yes/No12/33
Administration of durvalmab
        Yes/No2/43
Recurrent pattern
        Local recurrence/distant metastasis17/28
Intracranial metastases at recurrence
        Yes/No7/38
Liver metastases at recurrence
        Yes/No3/42
Bone metastases at recurrence
        Yes/No15/30
Oligorecurrrence
        Yes/No11/34
Radiotherapy after recurrence (any site)
        Yes/No19/26
Number of drug therapies after chemoradiotherapy
        0/1/2/3/414/18/9/2/2
        Median (range)1
Median (range) radiation dosage (Gy)60 (58–70)
Chemotherapy regimen
        CDDP + VNR1
        CDDP + S-10
        CBDCA + PTX30
        Low dose CBDCA14

Univariate Cox regression analysis of patient characteristics for post-progression survival

MedianPost-progression survival
PPSUnivariate analysisMultivariate analysis
Factors(months)HR95% CIp valueHR95% CIp value
Gender
        Male/female18.1/25.71.490.63–4.070.37
Age at recurrence (years)
        < 75 / 7520.0/19.50.780.36–1.770.54
PS at recurrence
        0–1 / 221.3/2.80.420.18–1.090.07
Smoking history
        Yes/No16.7/25.71.870.71–6.390.21
Histology
        Adenocarcinoma/non-adenocarcinoma25.7/10.50.370.17–0.790.00991.060.36–3.040.90
Driver mutation/translocation
        Yes/No27.3/15.10.320.07–0.950.0380.610.13–2.230.47
Best overall response of chemoradiotherapy
        PR/non-PR15.1/22.11.820.86–4.110.11
Progression-free survival
        < 6 months / 6 months6.4 / 24.41.970.89–4.190.09
Glasgow prognostic score (GPS) at recurrence
        0–1/225.7/6.70.230.11–0.520.00060.20.06–0.550.0019
Recurrence pattern
        Local recurrence/distant metastasis40.7/16.70.450.18–1.030.05
Intracranial metastases at recurrence
        Yes/No6.7/21.31.750.64–4.090.25
Liver metastases at recurrence
        Yes/No4.2/21.36.821.50–22.80.01612.72.40–56.80.0048
Bone metastases at recurrence
        Yes/No18.1/20.01.400.60–3.060.41
Oligorecurrence at recurrence
        Yes/No22.1/19.20.770.30–1.750.55

The treatments after post-chemoradiotherapy recurrence

first-linesecond-linethird-line≧fourth-lineTotal
Platinum combination1132016
Platinum combination + ICIs00000
Docetaxel04206
Docetaxel+ ramcirumab00000
Pemetrexed00202
S110034
Others (single agents)01001
EGFR-TKIs61007
ALK-TKIs31004
ICI monotherapy15219
Ipilimumab+nivolumab10001
Investigational agents00000
Radiotherapy alone1210013
Best supportive care10---10
DOI: https://doi.org/10.2478/raon-2022-0006 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
Language: English
Page range: 228 - 237
Submitted on: Nov 2, 2021
Accepted on: Jan 13, 2022
Published on: Feb 25, 2022
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
chemoradiotherapy,
Glasgow prognostic score,
locally advanced non-small cell lung cancer,
overall survival,
post-progression survival,
progression-free survival
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2022 Hisao Imai, Daijiro Kobayashi, Kyoichi Kaira, Sayaka Kawashima, Ken Masubuchi, Masumi Murata, Takeshi Ebara, Yoshizumi Kitamoto, Koichi Minato, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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