Short-term hospitalization, mortality risk varies by palliative chemotherapy regimen
medwireNews: Two independent studies of older patients receiving initial chemotherapy for metastatic breast cancer or non-small-cell lung cancer (NSCLC) have found that the risk for hospitalization or death may be predicted by the cytotoxic regimen used.
The authors of both studies believe that their findings may help to inform the chemotherapy choice for these patient populations.
For the breast cancer study, Kenneth Kehl (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and colleagues used the linked SEER–Medicare databases to identify 693 patients (aged 66–99 years) with stage IV disease who received 972 lines of palliative chemotherapy with one of the 10 most frequently used regimens. Of these, 19% resulted in hospitalization or death within 30 days of initiating treatment.
As reported in Cancer, the chemotherapy regimen was significantly associated with the risk for hospitalization or death after adjusting for multiple factors, including the number of lines of prior therapy and the time between diagnosis and treatment initiation.
Specifically, cyclophosphamide, when used in combination with docetaxel or doxorubicin, increased the risk of this endpoint by a significant 2.71- and 2.45-fold, respectively, compared with capecitabine, as did gemcitabine and docetaxel, by a corresponding 3.51- and 2.49-fold.
But treatment with doxorubicin, nab-paclitaxel, or paclitaxel – either given alone or alongside trastuzumab – was not associated with an increased likelihood of hospitalization or death versus capecitabine.
The second study drew on the same database and included 3310 patients (aged ≥66 years) who received carboplatin, with either pemetrexed or paclitaxel, for stage IV, nonsquamous NSCLC.
Of these, 2182 were included in a propensity-matched analysis, which showed that 20.7% of the patients treated with carboplatin–pemetrexed were hospitalized within 30 days of starting treatment, as were 26.0% of their counterparts given carboplatin–paclitaxel. This equated to a significant difference of 5.3 percentage points in favor of the pemetrexed combination.
The total number of hospitalizations by the 90-day mark was numerically lower in the carboplatin–pemetrexed than carboplatin–paclitaxel group (585 vs 647), but this difference was not statistically significant, report Gabriel Brooks (Geisel School of Medicine, Lebanon, New Hampshire, USA) and co-researchers.
However, the average hospital-free survival time at 90 days was significantly longer for carboplatin–pemetrexed-treated patients, at 68.4 versus 63.6 days for those who received carboplatin–paclitaxel.
And overall survival was “modestly but significantly improved” in the carboplatin–pemetrexed group compared with the carboplatin–paclitaxel group, with corresponding medians of 9.0 and 7.6 months, the investigators report in JAMA Network Open.
They conclude that “[i]nformation about hospitalization risk may provide valuable context for evaluating real-world cancer treatment outcomes.”
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