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Adjuvant chemotherapy for non-small-cell lung cancer in the elderly: a population-based study in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature124994
Source
J Clin Oncol. 2012 May 20;30(15):1813-21
Publication Type
Article
Date
May-20-2012
Author
Sinead Cuffe
Christopher M Booth
Yingwei Peng
Gail E Darling
Gavin Li
Weidong Kong
William J Mackillop
Frances A Shepherd
Author Affiliation
Princess Margaret Hospital, University Health Network, Toronto, Canada. sinead.cuffe@uhn.on.ca
Source
J Clin Oncol. 2012 May 20;30(15):1813-21
Date
May-20-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Antineoplastic Agents - adverse effects - therapeutic use
Carcinoma, Non-Small-Cell Lung - mortality - pathology - therapy
Chemotherapy, Adjuvant
Chi-Square Distribution
Electronic Health Records
Female
Hospitalization
Humans
Kaplan-Meier Estimate
Logistic Models
Lung Neoplasms - mortality - pathology - therapy
Male
Medical Record Linkage
Multivariate Analysis
Odds Ratio
Ontario
Physician's Practice Patterns - statistics & numerical data
Pneumonectomy - adverse effects - mortality
Registries
Retrospective Studies
Time Factors
Treatment Outcome
Abstract
Non-small-cell lung cancer (NSCLC) is predominantly a disease of the elderly. Retrospective analyses of the National Cancer Institute of Canada Clinical Trials Group JBR.10 trial and the Lung Adjuvant Cisplatin Evaluation (LACE) meta-analysis suggest that the elderly benefit from adjuvant chemotherapy. However, the elderly were under-represented in these studies, raising concerns regarding the reproducibility of the study results in clinical practice.
By using the Ontario Cancer Registry, we identified 6,304 patients with NSCLC who were treated with surgical resection from 2001 to 2006. Registry data were linked to electronic treatment records. Uptake of chemotherapy was compared across age groups: younger than 70, 70 to 74, 75 to 79, and = 80 years. As a proxy of survival benefit from chemotherapy, we compared survival of patients diagnosed from 2004 to 2006 with survival of those diagnosed from 2001 to 2003. Hospitalization rates within 6 to 24 weeks of surgery served as a proxy of severe chemotherapy-related toxicity.
In all, 2,763 (43.8%) of 6,304 surgical patients were elderly (age = 70 years). Uptake of adjuvant chemotherapy in the elderly increased from 3.3% (2001 to 2003) to 16.2% (2004 to 2006). Among evaluable elderly patients, 70% received cisplatin and 28% received carboplatin-based regimens. Requirements for dose adjustments or drug substitutions were similar across age groups. Hospitalization rates within 6 to 24 weeks of surgery were similar across age groups (28.0% for patients age
PubMed ID
22529258 View in PubMed
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Adjuvant chemotherapy for non-small cell lung cancer: practice patterns and outcomes in the general population of Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature127316
Source
J Thorac Oncol. 2012 Mar;7(3):559-66
Publication Type
Article
Date
Mar-2012
Author
Christopher M Booth
Frances A Shepherd
Yingwei Peng
Gail Darling
Gavin Li
Weidong Kong
William J Mackillop
Author Affiliation
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada. boothc@kgh.kari.net
Source
J Thorac Oncol. 2012 Mar;7(3):559-66
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - drug therapy - epidemiology - mortality
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Canada - epidemiology
Carboplatin - administration & dosage
Carcinoma, Large Cell - drug therapy - epidemiology - mortality
Carcinoma, Non-Small-Cell Lung - drug therapy - epidemiology - mortality
Carcinoma, Squamous Cell - drug therapy - epidemiology - mortality
Chemotherapy, Adjuvant
Cisplatin - administration & dosage
Female
Follow-Up Studies
Humans
Lung Neoplasms - drug therapy - epidemiology - mortality
Male
Middle Aged
Neoplasm Staging
Physician's Practice Patterns
Retrospective Studies
Survival Rate
Treatment Outcome
Vinblastine - administration & dosage - analogs & derivatives
Young Adult
Abstract
Adjuvant chemotherapy (ACT) is known to improve survival in patients with early-stage non-small cell lung cancer. Herein, we describe chemotherapy regimens used, dose modifications, survival, and treatment-related toxicity in the general population.
All cases of non-small cell lung cancer diagnosed in Ontario in the period 2004-2006 who underwent surgical resection (n = 3354) were identified using the Ontario Cancer Registry in this population-based retrospective cohort study. We linked electronic records of treatment to the registry to identify all cases treated with ACT (n = 1032) and describe drugs, regimens, and dosages delivered. As a proxy measure of ACT-related toxicity, we evaluated deaths and hospitalizations within 16 weeks of starting ACT. Factors associated with dose modification were evaluated by logistic regression. The Cox proportional hazards model was used to describe associations between patient-, disease-, and treatment-related factors and survival.
ACT regimens were identified for 584 of 1032 ACT cases. Almost all cases included cisplatin- or carboplatin-based regimens (478/584, 82%, and 99/584, 17%, respectively). The most common regimen was a vinroelbine/cisplatin doublet (412/584, 71%); 64% of these cases had a dose reduction or omission. Dose modification was not associated with inferior survival on multivariate analysis. Twelve percent of all ACT cases were admitted to hospital within 16 weeks of starting ACT, and there was a 1.6% death rate potentially attributable to ACT. Survival of all ACT cases was comparable with outcomes reported in clinical trials.
ACT regimens used, toxicity, and survival outcomes in the general population are comparable with those reported in clinical trials. Dose modifications used in clinical practice are not associated with inferior survival.
PubMed ID
22307012 View in PubMed
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Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10.

https://arctichealth.org/en/permalink/ahliterature164056
Source
J Clin Oncol. 2007 Apr 20;25(12):1553-61
Publication Type
Article
Date
Apr-20-2007
Author
Carmela Pepe
Baktiar Hasan
Timothy L Winton
Lesley Seymour
Barbara Graham
Robert B Livingston
David H Johnson
James R Rigas
Keyue Ding
Frances A Shepherd
Author Affiliation
Division of Medical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada. carmela.pepe@mail.mcgill.ca
Source
J Clin Oncol. 2007 Apr 20;25(12):1553-61
Date
Apr-20-2007
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Canada
Carcinoma, Non-Small-Cell Lung - drug therapy - mortality - pathology - surgery
Chemotherapy, Adjuvant
Cisplatin - therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Geriatric Assessment
Humans
Lung Neoplasms - drug therapy - mortality - pathology - surgery
Male
Maximum Tolerated Dose
Middle Aged
Neoplasm Staging
Pneumonectomy
Probability
Prognosis
Proportional Hazards Models
Risk assessment
Survival Analysis
Vinblastine - adverse effects - analogs & derivatives - therapeutic use
Abstract
Recent trials have shown significant survival benefit from adjuvant chemotherapy for non-small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10.
Pretreatment characteristics and survival were compared for 327 young ( 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young).
Baseline demographics by age were similar with the exception of histology (adenocarcinoma: 58% young, 43% elderly; squamous: 32% young, 49% elderly; P = .001) and performance status (PS; PS 0: 53% young, 41% elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95% CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9%) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1%) of 71 in the elderly (P = .13).
Despite elderly patients' receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.
PubMed ID
17442999 View in PubMed
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Chemotherapy for relapsed small cell lung cancer: a systematic review and practice guideline.

https://arctichealth.org/en/permalink/ahliterature164283
Source
J Thorac Oncol. 2007 Apr;2(4):348-54
Publication Type
Article
Date
Apr-2007
Author
Susanna Cheng
William K Evans
Denise Stys-Norman
Frances A Shepherd
Author Affiliation
Toronto-Sunnybrook Regional Cancer Centre, Toronto, Canada. chris.smith@mcmaster.ca
Source
J Thorac Oncol. 2007 Apr;2(4):348-54
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - administration & dosage - adverse effects
Carcinoma, Small Cell - chemistry - mortality - pathology
Clinical Trials, Phase III as Topic
Etoposide
Female
Humans
Infusions, Intravenous
Lomustine
Lung Neoplasms - drug therapy - mortality - pathology
Male
Maximum Tolerated Dose
Melphalan
Middle Aged
Neoplasm Recurrence, Local - drug therapy - mortality - pathology
Neoplasm Staging
Ontario
Practice Guidelines as Topic
Prognosis
Randomized Controlled Trials as Topic
Salvage Therapy
Survival Analysis
Topotecan - administration & dosage - adverse effects
Abstract
This clinical practice guideline, based on a systematic review, evaluates chemotherapy options for patients with relapsed small cell lung cancer (SCLC).
Relevant randomized trials and meta-analyses were identified through a systematic search of the literature. External feedback was obtained from practitioners in Ontario, and the guideline was approved by the provincial lung cancer disease site group.
Six randomized trials met the eligibility criteria and were included for review. One randomized phase III trial of oral topotecan versus no treatment in patients receiving best supportive care found topotecan to have a significant benefit in terms of 6-month survival and quality of life. A randomized phase III trial compared outcomes of carboplatin in patients receiving a combination of etoposide and cisplatin (EP) and found no significant improvement associated with carboplatin, although it was associated with significantly higher grade 3/4 thrombocytopenia. Two randomized trials directly compared chemotherapy regimens (intravenous [i.v.] topotecan versus cyclophosphamide, doxorubicin, and vincristine (CAV); and bis-chloro-ethylnitrosourea, thiotepa, vincristine, and cyclophosphamide (BTOC) versus EP), but these trials found no significant differences in terms of disease response or survival. I.v. topotecan was associated with significantly higher toxicities (grade 4 thrombocytopenia and grade 3/4 anemia) and greater improvement in patient-reported symptoms compared with CAV. Two randomized trials of topotecan-treated patients comparing route of administration (i.v. versus oral) found no significant differences in terms of disease response, survival, or quality of life, although oral administration was associated with increased grade 3 or 4 diarrhea in both trials.
Evidence on the clinical benefit of second-line therapy in SCLC is limited. Topotecan is the most studied agent in this population; it has a response and survival benefit in comparison with placebo, but it also has greater toxicity in comparison with CAV. To date, significant differences in terms of response and survival are not evident in studied chemotherapy options.
PubMed ID
17409809 View in PubMed
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A clinical prognostic index for patients treated with erlotinib in National Cancer Institute of Canada Clinical Trials Group study BR.21.

https://arctichealth.org/en/permalink/ahliterature156898
Source
J Thorac Oncol. 2008 Jun;3(6):590-8
Publication Type
Article
Date
Jun-2008
Author
Marie Florescu
Baktiar Hasan
Lesley Seymour
Keyue Ding
Frances A Shepherd
Author Affiliation
Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Hospital Site and University of Toronto, Toronto, Canada. marie.florescu.chum@ssss.gouv.qc.ca
Source
J Thorac Oncol. 2008 Jun;3(6):590-8
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Carcinoma, Non-Small-Cell Lung - drug therapy - mortality - pathology
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Lung Neoplasms - drug therapy - mortality - pathology
Male
Middle Aged
Neoplasm Staging
Ontario - epidemiology
Prognosis
Proportional Hazards Models
Protein Kinase Inhibitors - administration & dosage - therapeutic use
Quinazolines - administration & dosage - therapeutic use
Receptor, Epidermal Growth Factor - antagonists & inhibitors
Survival Rate
Time Factors
Abstract
BR.21 demonstrated significant survival benefit for non-small cell lung cancer patients receiving erlotinib compared with placebo. We undertook to characterize, by exploratory subset analysis, patients less likely to benefit from erlotinib.
Using stratification and potential prognostic factors, Cox regression with stepwise selection with minimum Akaike Information Criteria was used to separate erlotinib patients into risk categories based on 10th, 50th, and 90th percentiles of prognostic index scores. The hypothesis was that characteristics of treated patients in the highest risk group would be predictive of lack of benefit from erlotinib when comparing erlotinib to placebo patients in the same risk group.
Ten factors (smoking history, performance status, weight loss, anemia, lactic dehydrogenase, response to prior chemotherapy, time from diagnosis, number of prior regimens, epidermal growth factor receptor copy, and ethnicity) were predictive of overall survival for erlotinib-treated patients and were used in the final model. Four risk groups were derived from the index score of the Prognostic Model: Low Risk (HR = 0.34, p
PubMed ID
18520796 View in PubMed
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Economic analysis of the TAX 317 trial: docetaxel versus best supportive care as second-line therapy of advanced non-small-cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature191261
Source
J Clin Oncol. 2002 Mar 1;20(5):1344-52
Publication Type
Article
Date
Mar-1-2002
Author
Natasha B Leighl
Frances A Shepherd
Rita Kwong
Ronald L Burkes
Ronald Feld
Pamela J Goodwin
Author Affiliation
Department of Medical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada. Natasha.Leigh@uhn.on.ca
Source
J Clin Oncol. 2002 Mar 1;20(5):1344-52
Date
Mar-1-2002
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents, Phytogenic - therapeutic use
Canada
Carcinoma, Non-Small-Cell Lung - economics - therapy
Cost-Benefit Analysis
Costs and Cost Analysis
Hospitalization - economics
Humans
Lung Neoplasms - economics - therapy
Paclitaxel - analogs & derivatives - therapeutic use
Palliative Care - economics
Radiotherapy - economics
Retrospective Studies
Sensitivity and specificity
Taxoids
Abstract
To determine the cost-effectiveness (CE) of second-line docetaxel compared with best supportive care (BSC) in the TAX 317 trial, a randomized clinical trial of second-line chemotherapy in non-small-cell lung cancer.
A retrospective CE analysis of the TAX 317 trial was undertaken, evaluating direct medical costs of therapy from the viewpoint of Canada's public health care system. Costs were derived in 1999 Canadian dollars, and resource use was determined through prospective trial data.
The incremental survival benefit in the docetaxel arm over BSC was 2 months (P =.047). The CE of docetaxel was $57,749 per year of life gained. For patients treated with docetaxel 75 mg/m(2), the CE was $31,776 per year of life gained. In univariate sensitivity analyses, CE estimates were most sensitive to changes in survival, ranging from $18,374 to $117,434 with 20% variation in survival at the recommended dose. The largest cost center in both arms was hospitalization, followed by the cost of drugs, investigations, radiotherapy, and community care. BSC patients had fewer hospitalizations than patients in the chemotherapy arm and were more often palliated at home.
Although the decision to treat should not be based on economic considerations alone, our CE estimate of $31,776 per year of life gained (at the currently recommended dose of docetaxel) is within an acceptable range of health care expenditures, and the total costs of therapy are similar to those of second-line palliative chemotherapy for other solid tumors.
Notes
Comment In: J Clin Oncol. 2002 Sep 1;20(17):3750-1;author reply 3751-212202680
PubMed ID
11870178 View in PubMed
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Economic analysis: randomized placebo-controlled clinical trial of erlotinib in advanced non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature145373
Source
J Natl Cancer Inst. 2010 Mar 3;102(5):298-306
Publication Type
Article
Date
Mar-3-2010
Author
Penelope A Bradbury
Dongsheng Tu
Lesley Seymour
Pierre K Isogai
Liting Zhu
Raymond Ng
Nicole Mittmann
Ming-Sound Tsao
William K Evans
Frances A Shepherd
Natasha B Leighl
Author Affiliation
NCIC Clinical Trials Group, Kingston, ON, Canada.
Source
J Natl Cancer Inst. 2010 Mar 3;102(5):298-306
Date
Mar-3-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angiogenesis Inhibitors - adverse effects - economics - therapeutic use
Canada
Carcinoma, Non-Small-Cell Lung - drug therapy - economics - pathology
Cost-Benefit Analysis
Drug Costs
Female
Hospitalization - statistics & numerical data
Humans
International Cooperation
Lung Neoplasms - drug therapy - economics - pathology
Male
Middle Aged
Multicenter Studies as Topic
Protein Kinase Inhibitors - economics - therapeutic use
Protein-Tyrosine Kinases - antagonists & inhibitors
Quinazolines - adverse effects - economics - therapeutic use
Randomized Controlled Trials as Topic
Receptor, Epidermal Growth Factor - antagonists & inhibitors
Retrospective Studies
Treatment Outcome
Tumor Markers, Biological - analysis
Abstract
The NCIC Clinical Trials Group conducted the BR.21 trial, a randomized placebo-controlled trial of erlotinib (an epidermal growth factor receptor tyrosine kinase inhibitor) in patients with previously treated advanced non-small cell lung cancer. This trial accrued patients between August 14, 2001, and January 31, 2003, and found that overall survival and quality of life were improved in the erlotinib arm than in the placebo arm. However, funding restrictions limit access to erlotinib in many countries. We undertook an economic analysis of erlotinib treatment in this trial and explored different molecular and clinical predictors of outcome to determine the cost-effectiveness of treating various populations with erlotinib.
Resource utilization was determined from individual patient data in the BR.21 trial database. The trial recruited 731 patients (488 in the erlotinib arm and 243 in the placebo arm). Costs arising from erlotinib treatment, diagnostic tests, outpatient visits, acute hospitalization, adverse events, lung cancer-related concomitant medications, transfusions, and radiation therapy were captured. The incremental cost-effectiveness ratio was calculated as the ratio of incremental cost (in 2007 Canadian dollars) to incremental effectiveness (life-years gained). In exploratory analyses, we evaluated the benefits of treatment in selected subgroups to determine the impact on the incremental cost-effectiveness ratio.
The incremental cost-effectiveness ratio for erlotinib treatment in the BR.21 trial population was $94,638 per life-year gained (95% confidence interval = $52,359 to $429,148). The major drivers of cost-effectiveness included the magnitude of survival benefit and erlotinib cost. Subgroup analyses revealed that erlotinib may be more cost-effective in never-smokers or patients with high EGFR gene copy number.
With an incremental cost-effectiveness ratio of $94 638 per life-year gained, erlotinib treatment for patients with previously treated advanced non-small cell lung cancer is marginally cost-effective. The use of molecular predictors of benefit for targeted agents may help identify more or less cost-effective subgroups for treatment.
Notes
Comment In: J Natl Cancer Inst. 2010 Mar 3;102(5):287-820160167
PubMed ID
20160168 View in PubMed
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Gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non-small-cell lung cancer: a phase III trial of the Italian GEMVIN Investigators and the National Cancer Institute of Canada Clinical Trials Group.

https://arctichealth.org/en/permalink/ahliterature184706
Source
J Clin Oncol. 2003 Aug 15;21(16):3025-34
Publication Type
Article
Date
Aug-15-2003
Author
Cesare Gridelli
Ciro Gallo
Frances A Shepherd
Alfonso Illiano
Francovito Piantedosi
Sergio Federico Robbiati
Luigi Manzione
Santi Barbera
Luciano Frontini
Enzo Veltri
Brian Findlay
Silvio Cigolari
Robert Myers
Giovanni P Ianniello
Vittorio Gebbia
Giampietro Gasparini
Sergio Fava
Vera Hirsh
Andrea Bezjak
Lesley Seymour
Francesco Perrone
Author Affiliation
Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Naples, Italy. cgridelli@libero.it
Source
J Clin Oncol. 2003 Aug 15;21(16):3025-34
Date
Aug-15-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Canada
Carcinoma, Non-Small-Cell Lung - drug therapy - mortality
Cisplatin - administration & dosage
Deoxycytidine - administration & dosage - analogs & derivatives
Female
Humans
Italy
Lung Neoplasms - drug therapy - mortality
Male
Middle Aged
Quality of Life
Survival Analysis
Vinblastine - administration & dosage - analogs & derivatives
Abstract
Platinum-containing chemotherapy regimens are the standard treatment for patients with advanced non-small-cell lung cancer (NSCLC), although toxicity is common and may significantly affect the patient's quality of life (QoL). This trial aimed to assess whether a combination of gemcitabine and vinorelbine had benefits in terms of QoL, without influencing negatively on survival, compared with cisplatin-containing regimens.
Patients with stage IIIB (effusion and supraclavicular nodes) or IV documented NSCLC who were younger than 70 years of age were randomly assigned gemcitabine plus vinorelbine (GemVin) or either gemcitabine plus cisplatin or vinorelbine plus cisplatin (cisplatin-based). European Organization for Research and Treatment of Cancer scales were used for QoL analysis.
Five hundred one patients were randomly assigned to treatment. The median age was 62 years. There were no significant differences in global QoL scores between the two arms after 2 months of treatment. However, worsening scores for appetite, vomiting, and alopecia were significantly more common in the cisplatin-based arm. Median survival was 38 v 32 weeks and median progression-free survival was 23 v 17 weeks in the cisplatin-based versus GemVin arms, respectively. For the GemVin arm the hazard ratio for death was 1.15 (90% confidence interval [CI], 0.96 to 1.37) and the hazard ratio for progression was 1.29 (90% CI, 1.10 to 1.52). Grade 3 or 4 myelosuppression, vomiting, alopecia, and ototoxicity were significantly more frequent with cisplatin-based treatment.
Global QoL is not improved with GemVin, although advantages in some components of QoL were apparent. GemVin is less toxic than standard cisplatin-based chemotherapy. There is a nonsignificant slight survival advantage with cisplatin-based chemotherapy. GemVin could be offered to advanced NSCLC patients who express concern about toxicity.
Notes
Comment In: J Clin Oncol. 2003 Aug 15;21(16):3009-1012837812
PubMed ID
12837810 View in PubMed
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The influence of sex on efficacy, adverse events, quality of life, and delivery of treatment in National Cancer Institute of Canada Clinical Trials Group non-small cell lung cancer chemotherapy trials.

https://arctichealth.org/en/permalink/ahliterature144566
Source
J Thorac Oncol. 2010 May;5(5):640-8
Publication Type
Article
Date
May-2010
Author
Paul Wheatley-Price
Aurélie Le Maître
Keyue Ding
Natasha Leighl
Vera Hirsh
Lesley Seymour
Andrea Bezjak
Frances A Shepherd
Author Affiliation
Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Canada. pwheatleyprice@toh.on.ca
Source
J Thorac Oncol. 2010 May;5(5):640-8
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - drug therapy - mortality - pathology
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Canada
Carcinoma, Non-Small-Cell Lung - drug therapy - mortality - pathology
Carcinoma, Squamous Cell - drug therapy - mortality - pathology
Chemotherapy, Adjuvant
Clinical Trials, Phase III as Topic
Female
Humans
Lung Neoplasms - mortality - pathology - therapy
Male
Neoplasm Staging
Quality of Life
Randomized Controlled Trials as Topic
Retrospective Studies
Sex Factors
Treatment Outcome
Abstract
Female sex is a favorable prognostic factor in lung cancer. In small-cell lung cancer, women have been shown to experience greater toxicity from chemotherapy, but there are few studies of sex-related toxicity in non-small cell lung cancer (NSCLC).
This retrospective analysis evaluated the effect of sex on efficacy, adverse events (AEs), dose intensity (DI), and quality of life (QoL) in three phase III NSCLC trials conducted by the National Cancer Institute of Canada Clinical Trials Group; BR.10 (adjuvant chemotherapy), BR.14, and BR.18 (first-line advanced disease). Only patients with National Cancer Institute of Canada Clinical Trials Group data were included, and patients in the BR.10 observation arm were excluded.
Of 1,108 patients analyzed, 29% were female. On study entry, women were less likely to be overweight or obese (40% versus 51%, p
PubMed ID
20354457 View in PubMed
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Lung cancer risk in never-smokers: a population-based case-control study of epidemiologic risk factors.

https://arctichealth.org/en/permalink/ahliterature142873
Source
BMC Cancer. 2010;10:285
Publication Type
Article
Date
2010
Author
Darren R Brenner
Rayjean J Hung
Ming-Sound Tsao
Frances A Shepherd
Michael R Johnston
Steven Narod
Warren Rubenstein
John R McLaughlin
Author Affiliation
Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, 60 Murray St, Toronto M5T3L9, Canada.
Source
BMC Cancer. 2010;10:285
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Age of Onset
Aged
Aged, 80 and over
Air Pollution, Indoor - adverse effects
Case-Control Studies
Chi-Square Distribution
Female
Genetic Testing
Humans
Logistic Models
Lung Neoplasms - epidemiology - etiology
Male
Middle Aged
Occupational Exposure
Odds Ratio
Ontario - epidemiology
Pedigree
Respiratory Tract Diseases - complications - epidemiology
Risk assessment
Risk factors
Tobacco Smoke Pollution - adverse effects
Urban health
Young Adult
Abstract
We conducted a case-control study in the greater Toronto area to evaluate potential lung cancer risk factors including environmental tobacco smoke (ETS) exposure, family history of cancer, indoor air pollution, workplace exposures and history of previous respiratory diseases with special consideration given to never smokers.
445 cases (35% of which were never smokers oversampled by design) between the ages of 20-84 were identified through four major tertiary care hospitals in metropolitan Toronto between 1997 and 2002 and were frequency matched on sex and ethnicity with 425 population controls and 523 hospital controls. Unconditional logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between exposures and lung cancer risk.
Any previous exposure to occupational exposures (OR total population 1.6, 95% CI 1.4-2.1, OR never smokers 2.1, 95% CI 1.3-3.3), a previous diagnosis of emphysema in the total population (OR 4.8, 95% CI 2.0-11.1) or a first degree family member with a previous cancer diagnosis before age 50 among never smokers (OR 1.8, 95% CI 1.0-3.2) were associated with increased lung cancer risk.
Occupational exposures and family history of cancer with young onset were important risk factors among never smokers.
Notes
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PubMed ID
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