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Background Non-small cell lung cancer (NSCLC) is responsible for the most cancer-related deaths in the United States. A better understanding of treatment-related disparities and ways to address them are important to improving survival for patients with metastatic NSCLC. Materials and Methods We performed a retrospective analysis using the National Cancer Database. Included in this analysis were 107,116 patients with metastatic NSCLC who were treated at academic centers (AC), community-based centers (CC), and integrated centers (IC) between 2004 and 2015. The primary end point was overall survival, with comparisons of AC, CC, and IC. Results The survival disparity between AC and CC continued to grow over the study period, from a 5.7% difference in 2-year survival to a 7.5% difference. Treatment at IC was initially associated with survival similar to CC (hazard ratio [HR], 0.93), however, later in the study period treatment at IC improved (HR, 0.74) outpacing the improvement in survival in CC (HR, 0.82) but not to the same degree as the improvement in AC (HR, 0.64). The improvement in survival at IC was noted predominantly in patients with adenocarcinoma (HR, 0.72; P Conclusion Treatment of metastatic NSCLC at IC was associated with improved survival during our study period compared with treatment at CC. This appeared to be histology-dependent, suggesting a treatment-related improvement in survival because over this period newer therapies were preferentially available for adenocarcinoma. Integrating care across treatment facilities might be one way to bridge the growing gap in survival between AC and CC.

Lung cancer, compared with other solid tumors, is associated with high mortality rates from febrile neutropenia. The risk factors associated with in-hospital mortality were identified and compared for patients with lung cancer and patients with other solid tumors. Hospitalization data from the University Health Consortium database inclusive of 2004 to 2012 were analyzed. The study population included all adult patients with solid tumors who developed neutropenia. Cancer type, the presence of neutropenia, and further subgroups were determined using International Classification of Diseases, 9th revision, Clinical Modification codes. The primary study outcome was in-hospital mortality in lung cancer patients versus those with other solid tumors. Further analysis concentrated on comparisons of the 2 groups. The analysis included data from 11,111 lung cancer patients and 49,975 patients with other solid tumors. Overall, 4290 patients (7.0%) died. Lung cancer was associated with highest mortality (11.2% compared with other solid tumors, 6.1%; P < .0001). The lung cancer patients were older and more likely to have multiple comorbidities, and the risk of mortality was directly related to the number of comorbidities. Four additional risk factors for mortality were identified: pneumonia, sepsis, any infection, and intensive care unit stay. Pneumonia occurred more commonly in the lung cancer patients (26.4% vs. 10.3%) and was associated with comorbid pulmonary disease, which also occurred more often in the lung cancer patients (52.1% vs. 24.0%). We found that lung cancer patients presenting with febrile neutropenia were older, had more comorbidities, had a greater incidence of comorbid pulmonary disease, and were more likely to have pneumonia. Awareness of these risk factors for mortality should guide clinicians for more personalized approaches to chemotherapy, supportive care decisions, pneumonia and comorbidities.

Introduction The patterns of failure after resection of non–small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis. Materials and Methods The present institutional review board–approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored. Results Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT ( P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT ( P = .59). Conclusion Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.

The incidence of small-cell lung cancer (SCLC) has decreased over several decades. Sixty-eight thousand six hundred eleven patients with SCLC in the National Cancer Data Base (NCDB) were analyzed to describe demographic, treatment, and survival changes between 1992 and 2007.Four patient cohorts-diagnosed in 1992, 1997, 2002, and 2007-were examined. Univariate and multivariate analyses were performed to determine changes in demographic and treatment factors and their effect on survival of limited SCLC (LSCLC) and extensive SCLC (ESCLC).The proportion of female patients increased, whereas the proportion of non-Hispanic white patients decreased. Median survival for patients with ESCLC and LSCLC was 6.1 and 12.9 months, respectively, and was not significantly improved between patients diagnosed in 1992 and 2002. Improved survival was associated with female sex, age70 years, and receipt of surgery for patients with LSCLC. Radiation therapy decreased the hazard ratio (HR) for patients with stage III LSCLC but not for patients with earlier stage disease. Chemotherapy decreased the HR for all patients with LSCLC. Patients with ESCLC treated with radiation in addition to chemotherapy had better survival than those who received only chemotherapy.Despite changes in demographics and treatment, the median and 5-year survival rates for patients with SCLC have not significantly improved over the past 15 years. Surgery was associated with improved survival in LSCLC. The benefit of chemotherapy and/or radiation therapy was dependent on American Joint Committee on Cancer (AJCC) stage. AJCC staging information had prognostic and treatment ramifications and should be collected in future studies and databases.

Almost 70% of all patients with lung cancer in the United States are65 years of age, and the incidence of small-cell lung cancer (SCLC) increases with age until the eighth decade of life. However, elderly patients are underrepresented in clinical trials and are often suboptimally treated. The validity of age as a prognostic factor for toxicity or survival remains controversial.To investigate the safety and efficacy of topotecan (an approved treatment for relapsed SCLC) in older patients, we performed a retrospective analysis in patientsor= 65 years of age versus patients65 years of age from 5 large topotecan trials. In all 5 trials, patients received topotecan 1.5 mg/m2 per day via a 30-minute intravenous infusion on days 1 through 5 of a 21-day cycle. Efficacy and tolerability outcomes were assessed for both age groups.Topotecan was similarly tolerated in both age groups, with generally manageable hematologic toxicity. The incidence, duration, and onset of severe hematologic toxicities did not vary significantly with age. In the65 age group, grade 4 neutropenia and leukopenia were reported in 72% and 32% of patients, respectively; in theor= 65 age group, grade 4 neutropenia and leukopenia were reported in 77% and 31% of patients, respectively. Grade 4 thrombocytopenia was less common in the65 age group. Nonhematologic toxicities, median time to progression, and overall survival were comparable between groups.This is the first demonstration of the safety and efficacy of topotecan in older patients with recurrent SCLC. Future studies are needed to fully characterize the role of topotecan in the treatment of older patients.

The purpose of this study was to examine the safety and efficacy of carboplatin/etoposide/paclitaxel in patients with untreated stage IV non–small-cell lung cancer (NSCLC) and extensive small-cell lung cancer (SCLC). Carboplatin was administered intravenously (I.V.) at an area under the curve (AUC) of 6 with etoposide at either 80 or 100 mg/m 2 I.V. days 1-3 and paclitaxel at 175 or 200 mg/m 2 I.V. over 3 hours along with 5 μg/kg of granulocyte colony-stimulating factor subcutaneously on days 4-18, repeated every 3 weeks for 6 courses. Thirty-one patients (five NSCLC and 26 SCLC) entered into this phase I study. The median age was 63 (range, 42 to 74 years), with 24 males and seven females. The recommended dose level for phase II testing was carboplatin AUC=6, etoposide 80 mg/m 2 days 1-3, and paclitaxel 175 mg/m 2 over 3 hours. With seven patients at this level, 14% had grade 4 neutropenia, 14% had grade 4 thrombocytopenia, none had grade 2/3 neurotoxicity, and no toxic deaths occurred. One of five (20%) patients with NSCLC responded, and 19 of 22 (86%) evaluable SCLC patients experienced a response to therapy. SCLC patients had a median survival of 10 months. The combination of carboplatin/etoposide/paclitaxel has significant activity with acceptable toxicity in patients with extensive SCLC.

Gene therapy is emerging as a promising modality for the treatment of lung cancer. Diverse strategies employing gene therapy for lung cancer have been investigated in vitro and in animal models, and a number of these approaches have met with promising results. Several phase I and II clinical trials have been undertaken, and early results suggest that it may be safe to administer gene therapy to lung cancer patients. It remains to be determined whether this modality will be efficacious as primary or adjunctive therapy in the setting of lung cancer.

The standard treatment of limited-stage small-cell lung cancer (LS-SCLC) has changed over the past 15 years. Standard treatment for LS-SCLC currently involves multiple-agent chemotherapy and early concurrent thoracic radiation therapy. Four patient cohorts (total number of patients, 22,969) diagnosed with LS-SCLC in 1985 (N=2123), 1990 (N=6279), 1995 (N=7815), and 2000 (N=6752) were studied in order to describe demographic and treatment pattern changes as well as 5-year survival rates across cohorts. Women composed 40.2% of patients in the 1985 cohort but represented a significant proportional increase over each successive cohort, representing 50.8% of the 2000 cohort. The proportion of patients agedor=70 years also significantly increased over time, from 31.6% in 1985 to 44.9% in 2000 (P0.001). Over these years, the use of chemoradiation as the primary treatment for patients with LS-SCLC increased from 34.6% to 51.9% (from 37% to 60.5% for patients aged70 years, and from 29.5% to 41.3% for patients agedor=70 years). During the same time, the use of chemotherapy as the sole treatment decreased from 30.7% in 1985 to 21.7% in 2000. Chemotherapy as the sole treatment was used in 25.9% of the populationor=70 years of age in 2000, compared with 18.3% in patients aged70 years. The percent of patients for which there was no treatment given did not change significantly between the cohorts (14.3% in 1985 and 13.7% in 2000; P0.001). The 5-year survival rates and 95% confidence intervals (CIs) for the 1985, 1990, and 1995 cohorts of all ages of patients treated with chemoradiation therapy are as follows: 10.5% (CI, 6.75%-14.25%), 11.88% (CI, 9.63%-14.13%), and 13.3% (CI, 11.2%-15.4%). Between 1985 and 2000 there was a significant increase in the percentage of women diagnosed with LS-SCLC. The use of combined chemotherapy and radiation therapy also increased during this period. This increase in chemoradiation therapy was associated with a decreased use of chemotherapy alone. Despite changes in demographics and treatment during these time intervals, the 5-year survival for patients with LS-SCLC treated with chemoradiation therapy did not increase significantly. These results demonstrate the continued need for the evaluation of new treatments in this group of patients.

A retrospective subset analysis of anemic lung cancer patients who participated in three large, multicenter, community-based studies of 3-times-weekly (TIW) or once-weekly (QW) recombinant human erythropoietin (r-HuEPO, epoetin alfa) as an adjunct to chemotherapy was conducted. Patients were treated with epoetin alfa 150 U/kg in the first TIW study and with 10,000 U subcutaneously in the other study, with doubling of the dose if hemoglobin (Hb) response was inadequate. Patients in the QW study received epoetin alfa 40,000 U subcutaneously, which could be increased to 60,000 U. The maximum treatment duration for all three studies was 16 weeks. A total of 1748 lung cancer patients were evaluable for hematopoietic response; 1298 were evaluable for analyses of energy and 1300 were evaluable for analyses of activity and overall quality of life (QOL), as measured by the linear analogue scale assessment (LASA). Within 2 months of therapy, TIW and QW epoetin alfa therapy resulted in significant increases in Hb levels, decreases in transfusion requirements, and improvements in self-reported LASA scores. Increased Hb levels and reduced transfusion rates were demonstrated in the individual studies and in the analysis of data pooled from all three studies. Improvements in QOL parameters were significantly correlated with increased Hb levels. Epoetin alfa was well tolerated in all studies. The clinical benefits and safety profiles of the TIW and the QW schedules appear to be similar. In addition, the QW schedule provides greater convenience to patients and physicians alike. Given the high incidence of anemia and transfusion utilization in patients presenting with lung cancer, epoetin alfa is an effective strategy for correcting anemia in these patients, thereby improving their energy levels, activity levels, and overall QOL.