Results of platinum-based chemotherapy in unselected performance status (PS) 2 patients with advanced non-small cell lung cancer: a cohort study

Recent phase-III trials show that platinum-based chemotherapy (PBCT) for patients with advanced non-small cell lung cancer and poor performance status (PS) improves survival without increasing toxicity, compared to single-agent chemotherapy (CT). The aim of this study was to asses whether these results are transposable in a community population. About 260 consecutive patients with stage IIIB–IV NSCLC (25 % with PS 2) receiving a PBCT were prospectively included in the study and retrospectively analyzed. No difference was observed between PS 0–1 and 2 patients regarding tumor-control rate, symptom relief, and grade III–V toxicity. Median and 1-year survival of PS 2 patients was 6.2 months and 32 %, respectively. PS 1 and PS 2 patients continuing first-line CT beyond the first course shared the same survival. On the other hand, more PS 2 (31.8 vs. 9.3 % of PS 0–1 patients, p < 0.001) discontinued first-line CT after the first course with a poor clinical outcome. They were more likely to have lost weight and to have a high comorbidity score. PBCT in unselected PS 2 patients achieved survival rates similar to those observed in clinical trials, with no increase in toxicity. PS 2 patients continuing CT beyond the first course shared the same prognosis than PS 1 patients. However, almost one-third of PS 2 patients discontinued CT after the first course. Their prognosis was poor.