Incidence, Correlates, and Prognostic Significance of Mixed Response in Advanced Non-small Cell Lung Cancer.

Abstract

BACKGROUND:

Mixed response (MR), a scenario featuring discordant tumor changes, has been reported primarily with targeted therapies or immunotherapy. We determined the incidence and prognostic significance of MR in advanced non-small cell lung cancer (NSCLC) treated with cytotoxic chemotherapy.

PATIENTS AND METHODS:

We analyzed patient-level data from ECOG-ACRIN E5508 (carboplatin-paclitaxel + bevacizumab induction followed by randomization to maintenance therapy regimens). For patients with at least 2 target lesions and available measurements after cycle 2, we characterized response as homogeneous response (HR, similar behavior of all lesions), MR (similar behavior but >30% difference in magnitude of best and least responding lesions), or true mixed response (TMR, best and least responding lesions showing different behavior: ≥10% growth versus ≥10% shrinkage). We compared category characteristics using Mann-Whitney U and Chi-square tests, and overall survival (OS) using log-rank test and Cox models.

RESULTS:

Among 965 evaluable patients, HR occurred in 609 patients (63%), MR in 208 (22%), and TMR in 148 (15%). Median OS was 13.6 months for HR, 12.0 months for MR, and 7.6 months for TMR (P < .001). Compared to HR, TMR had inferior OS among stable disease cases (HR 1.62; 95% CI, 1.23-2.12; P < .001) and a trend toward inferior OS among progressive disease cases (HR 1.39; 95% CI, 0.83-2.33; P = .2). In multivariate analysis, TMR was associated with worse OS (HR 1.48; 95% CI, 1.22-1.79; P < .001).

CONCLUSION:

True mixed response occurs in a substantial minority of lung cancer cases treated with chemotherapy and independently confers poor prognosis.

• Authors: David E Gerber, Yating Wang, Suresh S Ramalingam, Sheena Bhalla, Zhuoxin Sun, Hossein Borghaei, Julie R Brahmer, Joan H Schiller
• Journal: The oncologist (Oncologist) Vol. 29 Issue 4 Pg. 342-349 (Apr 04 2024) ISSN: 1549-490X [Electronic] England
• PMID: 38207008 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2024. Published by Oxford University Press.

Chemical References

• Carboplatin
• Paclitaxel

Topics

• Humans
• Carcinoma, Non-Small-Cell Lung (drug therapy, epidemiology)
• Lung Neoplasms (drug therapy, epidemiology)
• Prognosis
• Incidence
• Proportional Hazards Models
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carboplatin (therapeutic use)
• Paclitaxel (therapeutic use)