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Comparison between single-agent and combination chemotherapy as second-line treatment for advanced non-small cell lung cancer: a multi-institutional retrospective analysis

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Abstract

Purpose

Doublet combination chemotherapy is commonly considered a second-line treatment for advanced non-small cell lung cancer (NSCLC) in China. This multi-institutional retrospective analysis evaluated and compared the efficacy between combination and mono-therapy after platinum-based first-line chemotherapy in Chinese patients with advanced NSCLC.

Methods

We retrospectively reviewed 335 patients who received second-line chemotherapy for advanced NSCLC. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), response rate (RR) and toxicity. Treatment-free interval (TFI) was used for further stratification analysis. The Cox proportional hazards model was used for multivariate analysis.

Results

Two hundred and fifty-three patients received doublet combination chemotherapy and 82 received single-agent chemotherapy. PFS was significantly prolonged in combination group compared to single-agent group (median 5.70 vs 3.70 months; HR 0.62; 95% CI 0.45–0.85; p < 0.001). The RR was significantly higher in the combination group than in the single-agent group (29.25% vs. 10.98%; p = 0.001). OS was also prolonged in combination group versus single-agent group (median 13.30 vs. 11.45 months, respectively; HR 0.70; 95% CI 0.52–0.95; p = 0.023). Among patients with TFI of ≥ 6 months, PFS and OS of the combination group were significantly increased than the single-agent group (median PFS, 6.67 vs. 3.80 months, p = 0.002; median OS, 13.60 vs. 11.45 months, p = 0.013). Grade III/IV toxicity was similar between the two groups (p = 0.113). Through multivariate analyses, we found that Eastern Cooperative Oncology Group (ECOG) score (p < 0.001), further-line treatment (p < 0.001) and combination chemotherapy (p = 0.024) were the independent prognostic factors.

Conclusion

Compared with mono-therapy, combination chemotherapy was a better second-line option for Chinese patients with good performance status, especially in those with TFI of ≥ 6 months.

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Acknowledgements

This research was supported by Shandong Provincial Natural Science Foundation (ZR2011HQ021 and ZR2013HM079)

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Author notes

  1. Jie Liu and Bao Song contributed equally to this work and should be considered co-Correspondence authors.

  2. Yanjiao Yi and Zining Liu contribute equally.

Authors and Affiliations

  1. Department of Radiotherapy, Yantai YuHuangDing Hospital, Yantai, Shandong, China

    Yanjiao Yi

  2. Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, **an, 250117, Shandong, China

    Yanjiao Yi, Chao **e & Jie Liu

  3. Department of Oncology, Affiliated Hospital of Shandong Academy of Medical Sciences, Shandong First Medical University and Shandong Academy of Medical Sciences, **an, Shandong, China

    Zining Liu

  4. Department of Oncology, Changqing District People’s Hospital, **an, Shandong, China

    Lihua Fang

  5. Department of Oncology, General Hospital of **an Iron and Steel Group Limited Company, **an, Shandong, China

    Jianzhong Li

  6. Department of Oncology, Affiliated Hospital of Taishan Medical College, Taian, Shandong, China

    Wenjian Liu

  7. Department of Oncology, People’s Hospital of Yuncheng, Heze, Shandong, China

    Fuxia Wang

  8. Department of Oncology, People’s Hospital of Zhangqiu, **an, Shandong, China

    ** Fu

  9. Basic Laboratory, Department of Oncology Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, **an, 250117, Shandong, China

    Bao Song

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  1. Yanjiao Yi
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Yi, Y., Liu, Z., Fang, L. et al. Comparison between single-agent and combination chemotherapy as second-line treatment for advanced non-small cell lung cancer: a multi-institutional retrospective analysis. Cancer Chemother Pharmacol 86, 65–74 (2020). https://doi.org/10.1007/s00280-020-04091-3

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