Abstract
Purpose
In advanced non-small cell lung cancer (NSCLC), progressive disease burdens patients considerably. Second-line (2L) chemotherapy
improves survival marginally but humanistic outcomes (i.e., quality of life, QOL) are underreported. The impact of 2L therapy
remains an important consideration for patients and caregivers, and there have been QOL reviews for 1L, but not 2L, therapies.
This review assessed QOL outcomes of approved, guideline-supported 2L chemotherapy with docetaxel, erlotinib, gefitinib, and
pemetrexed in advanced NSCLC.
improves survival marginally but humanistic outcomes (i.e., quality of life, QOL) are underreported. The impact of 2L therapy
remains an important consideration for patients and caregivers, and there have been QOL reviews for 1L, but not 2L, therapies.
This review assessed QOL outcomes of approved, guideline-supported 2L chemotherapy with docetaxel, erlotinib, gefitinib, and
pemetrexed in advanced NSCLC.
Methods
Clinical trial reports of approved, guideline-supported 2L or maintenance therapy for NSCLC published from 2000 to 2010 were
identified from PubMed/Medline and clinical meetings. Outcomes were stratified by overall QOL impact, domain/symptom-specific
effects, effect over time, and subgroup effects.
identified from PubMed/Medline and clinical meetings. Outcomes were stratified by overall QOL impact, domain/symptom-specific
effects, effect over time, and subgroup effects.
Results
Of 145 studies identified, 24 full-text articles were retained. Studies with docetaxel versus best supportive care (n = 1) and active comparators (n = 4) reported non-significant overall QOL improvements, as did studies of gefitinib versus placebo and active comparator
(n = 7). Overall QOL improvements were seen for gefitinib versus docetaxel (n = 2) and gefitinib in a single-arm study (n = 1). At the symptom level, studies of docetaxel (n = 4/7), gefitinib (n = 7/9), and pemetrexed (n = 1) reported non-significant results. Subgroup analyses indicated improved QOL outcomes for gefitinib-treated responders
versus non-responders, worse QOL for gefitinib-treated smokers versus placebo, worse QOL for gefitinib-treated Asian patients
versus placebo, and longer time to symptom deterioration in erlotinib versus placebo-treated elderly patients.
(n = 7). Overall QOL improvements were seen for gefitinib versus docetaxel (n = 2) and gefitinib in a single-arm study (n = 1). At the symptom level, studies of docetaxel (n = 4/7), gefitinib (n = 7/9), and pemetrexed (n = 1) reported non-significant results. Subgroup analyses indicated improved QOL outcomes for gefitinib-treated responders
versus non-responders, worse QOL for gefitinib-treated smokers versus placebo, worse QOL for gefitinib-treated Asian patients
versus placebo, and longer time to symptom deterioration in erlotinib versus placebo-treated elderly patients.
Conclusions
Significant improvements in overall QOL with 2L chemotherapy for advanced NSCLC were infrequent. Single-arm studies and those
with less toxic regimens more commonly provided statistically significant improvements in QOL outcomes. Methodological heterogeneity
impedes cross-study QOL comparisons.
with less toxic regimens more commonly provided statistically significant improvements in QOL outcomes. Methodological heterogeneity
impedes cross-study QOL comparisons.
- Content Type Journal Article
- Category Review
- Pages 1-12
- DOI 10.1007/s11136-012-0229-0
- Authors
- Arijit Ganguli, Abbott Laboratories, 200 Abbott Park Road, GMH1, AP30-3NW, Abbott Park, IL 60064, USA
- Phillip Wiegand, Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814, USA
- Xin Gao, Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814, USA
- John A. Carter, Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814, USA
- Marc F. Botteman, Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814, USA
- Saurabh Ray, Abbott Laboratories, 200 Abbott Park Road, GMH1, AP30-3NW, Abbott Park, IL 60064, USA
- Journal Quality of Life Research
- Online ISSN 1573-2649
- Print ISSN 0962-9343