A current forecast [1] for the year 2015, which is based on statistics from the WHO and data from individual European countries, indicates that theThe picture regarding lung cancer is bleak: as a cause of death, it will outnumber or even overtake breast cancer among women – it is one of the few tumors that is on the rise in terms of mortality and belies the overall positive trend for the remaining types of cancer. Given the topicality of this disease, intensified research is an important task. The question of whether to include more patients in studies who have already suffered from a tumor has now been examined.
The registry study [2] compared the survival of lung cancer patients who had previously developed cancer with that of previously cancer-free individuals. Patients with previous tumor usually meet the exclusion criteria of lung cancer trials. The central question posed by the Dallas researchers was whether such patients should be increasingly included in the future. The team, led by Andrew L. Laccetti, Dallas, wanted to see if concerns about altered outcomes were borne out and what impact a former cancer actually has on survival.
Survival even prolonged
From one registry (1992-2009), 102 929 patients, older than 65 years, with stage IV lung cancer were identified. Just under 15% of these had a previous (other) tumor in their medical history (predominantly localized forms, usually diagnosed five or fewer years before lung cancer). Prostate, gastrointestinal, urogenital, and breast tumors accounted for the majority.
At first glance, it was surprising that overall and lung cancer-specific survival even improved in these patients (HR 0.93 and 0.81, respectively) – this after accounting for various concomitant factors. However, on closer examination, this finding is not so far-fetched and can be well explained, for example, by a higher frequency of medical care for former cancer patients: Lung cancer may have been detected and therapeutically addressed earlier. The basic biological conditions for fighting the tumor may also be better in survivors. Of course, these are only assumptions – but they are certainly plausible.
To test the relevance of the results for actual research as well, the authors additionally assembled a population that would be suitable for studies (<75 years, no comorbidities, treated with chemotherapy), and again found the same trend in survival.
Also, none of the predefined subgroups (stage, type of previous tumor, time of initial diagnosis) showed inferiority to patients without former disease, which is why the authors suggest considering the broader inclusion of such patients in lung cancer trials.
Literature:
- Malvezzi M, et al: European cancer mortality predictions for the year 2015: does lung cancer have the highest death rate in EU women? Ann Oncol 2015. doi: 10.1093/annonc/mdv001. First published online: January 26, 2015.
- Laccetti AL, et al: Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual. J Natl Cancer Inst 2015; 107(4): djv002. doi: 10.1093/jnci/djv002.
InFo ONCOLOGY & HEMATOLOGY 2015; 3(6): 4.
