PMID- 32950428
OWN - NLM
STAT- MEDLINE
DCOM- 20210727
LR  - 20220531
IS  - 1879-4076 (Electronic)
IS  - 1879-4068 (Print)
IS  - 1879-4068 (Linking)
VI  - 12
IP  - 4
DP  - 2021 May
TI  - Toxicity and survival outcomes in older adults receiving concurrent or sequential 
      chemoradiation for stage III non-small cell lung cancer in Alliance trials 
      (Alliance A151812).
PG  - 563-571
LID - S1879-4068(20)30432-X [pii]
LID - 10.1016/j.jgo.2020.09.005 [doi]
AB  - INTRODUCTION: Optimal treatment for older adults with stage III non-small cell 
      lung cancer (NSCLC) remains unclear. Here we hypothesized that sequential 
      chemoradiation therapy (sCRT) is better tolerated than concurrent (cCRT) but 
      confers acceptable efficacy. We evaluated these strategies in older adults 
      utilizing Alliance for Clinical Trials in Oncology data. MATERIALS AND METHODS: 
      Pooled analyses from 6 first-line stage III NSCLC CRT trials (Cancer and Leukemia 
      Group B 8433, 8831, 9130, 30106, 30407, 39801) were used to compare toxicity and 
      survival outcomes with cCRT versus sCRT in patients age >/= 65 years. Grade 3-5 
      adverse events (AEs), progression-free and overall survival (PFS; OS) are 
      reported with adjustment for covariates. RESULTS: Four hundred older adults, of 
      whom 106 (26.5%) had received sCRT and 294 (73.5%) had received cCRT, comprised 
      the cohorts. Virtually all had an Eastern Cooperative Oncology Group performance 
      status (ECOG PS) 0-1 (99%). More grade 3-5 AEs were observed at any time-point 
      with cCRT than sCRT (94.2% versus 86.8%; 95% confidence interval for difference 
      in proportions, 1.3%, 15.5%) and this finding remained after adjusting for length 
      of study treatment (P = 0.018). Comparable PFS and OS were observed with sCRT 
      versus cCRT (median: 8.0 versus 9.2 months; median: 11.9 versus 13.4 months, 
      respectively) even after adjustment for age, sex, ECOG PS, body mass index, 
      pretreatment weight loss, stage, and cisplatin-based therapy (P = 0.604 and 
      P = 0.906, respectively). DISCUSSION: These data show that sCRT was associated 
      with less toxicity than cCRT with no associated statistically significant 
      decrease in efficacy outcomes and that sCRT merits further study in this 
      population.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Maggiore, Ronald J
AU  - Maggiore RJ
AD  - University of Rochester, Rochester, NY, United States of America.
FAU - Zahrieh, David
AU  - Zahrieh D
AD  - Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of 
      America; Mayo Clinic, Rochester, MN, United States of America. Electronic 
      address: zahrieh.david@mayo.edu.
FAU - McMurray, Ryan P
AU  - McMurray RP
AD  - Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of 
      America; Mayo Clinic, Rochester, MN, United States of America.
FAU - Feliciano, Josephine L
AU  - Feliciano JL
AD  - Johns Hopkins University, Baltimore, MD, United States of America.
FAU - Samson, Pamela
AU  - Samson P
AD  - Washington University School of Medicine, St. Louis, MO, United States of 
      America.
FAU - Mohindra, Pranshu
AU  - Mohindra P
AD  - University of Maryland, Baltimore, MD, United States of America.
FAU - Chen, Hongbin
AU  - Chen H
AD  - Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
FAU - Wong, Melisa L
AU  - Wong ML
AD  - University of California, San Francisco, CA, United States of America.
FAU - Lafky, Jacqueline M
AU  - Lafky JM
AD  - Mayo Clinic, Rochester, MN, United States of America.
FAU - Jatoi, Aminah
AU  - Jatoi A
AD  - Mayo Clinic, Rochester, MN, United States of America.
FAU - Le-Rademacher, Jennifer G
AU  - Le-Rademacher JG
AD  - Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of 
      America; Mayo Clinic, Rochester, MN, United States of America.
LA  - eng
GR  - K76 AG064431/AG/NIA NIH HHS/United States
GR  - U10 CA180821/CA/NCI NIH HHS/United States
GR  - UG1 CA232760/CA/NCI NIH HHS/United States
GR  - UG1 CA189823/CA/NCI NIH HHS/United States
GR  - UG1 CA233191/CA/NCI NIH HHS/United States
GR  - U10 CA180882/CA/NCI NIH HHS/United States
GR  - UG1 CA233196/CA/NCI NIH HHS/United States
GR  - P30 AG044281/AG/NIA NIH HHS/United States
GR  - UG1 CA233339/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20200916
PL  - Netherlands
TA  - J Geriatr Oncol
JT  - Journal of geriatric oncology
JID - 101534770
RN  - Q20Q21Q62J (Cisplatin)
SB  - IM
MH  - Aged
MH  - Antineoplastic Combined Chemotherapy Protocols/adverse effects
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - Chemoradiotherapy/adverse effects
MH  - Cisplatin/therapeutic use
MH  - Humans
MH  - *Lung Neoplasms/drug therapy
PMC - PMC7960567
MID - NIHMS1629968
OTO - NOTNLM
OT  - Chemoradiation
OT  - Geriatric
OT  - Lung cancer
OT  - Older adults
OT  - Outcomes
OT  - Stage III
COIS- Declaration of Competing Interest Dr. Wong has reported a conflict of interest 
      outside of the submitted work (immediate family member is an employee of 
      Genentech with stock ownership). No other authors have reported a conflict of 
      interest.
EDAT- 2020/09/21 06:00
MHDA- 2021/07/28 06:00
PMCR- 2022/05/01
CRDT- 2020/09/20 20:26
PHST- 2020/04/17 00:00 [received]
PHST- 2020/06/17 00:00 [revised]
PHST- 2020/09/01 00:00 [accepted]
PHST- 2020/09/21 06:00 [pubmed]
PHST- 2021/07/28 06:00 [medline]
PHST- 2020/09/20 20:26 [entrez]
PHST- 2022/05/01 00:00 [pmc-release]
AID - S1879-4068(20)30432-X [pii]
AID - 10.1016/j.jgo.2020.09.005 [doi]
PST - ppublish
SO  - J Geriatr Oncol. 2021 May;12(4):563-571. doi: 10.1016/j.jgo.2020.09.005. Epub 
      2020 Sep 16.