Quality of Life Achieved by Carboplatin Plus Etoposide as Third-Line Chemotherapy Compared with Best Supportive Care in Non-Small Cell Lung Cancer Stage IIIB/IV.

BACKGROUND: Advanced stage (IIIB/IV) non-small cell lung cancers (NSCLC) are mostly treated with paclitaxel or gemcitabine combination chemotherapy as first-line treatment and docetaxel as second-line therapy under the national reimbursement program, but there is no treatment specified for use after disease progression. New third-line chemotherapy drugs including new targeted therapies are expensive and bring about only slightly prolonged progression-free survival and minimally better response in healthy patients.

OBJECTIVE: Carboplatin plus etoposide chemotherapy, which was formerly used as a low-cost first-line treatment, was used as third-line therapy for advanced NSCLC in order to compare its results with those of best supportive care as a treatment for improved quality of life (QoL) and progression-free survival.

MATERIAL AND METHOD: This prospective study of advanced NSCLC stage IIIB/IV enrolled 47 patients receiving either third-line chemotherapy with carboplatin plus etoposide or best supportive care in the Oncology Unit, Medicine Department, Rajavithi Hospital from 1 January 2005 to 31 December 2012. Results of treatment and quality of life of the two groups (QoL) were evaluated using the Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L).

RESULTS: The 47 advanced NSCLC patients were given either carboplatin plus etoposide chemotherapy (27 cases) or best supportive care (20 cases). No statistically significant differences were found in baseline characteristics and quality of life in the two groups. The median progression-free survival after two months was significantly higher (88.9% vs. 75.0%, p-value < 0.001) in the chemotherapy group than in the best supportive care group, but no there were no statistically significant differences between QoL of patients in the two groups.

CONCLUSION: Carboplatin plus etoposide as third-line chemotherapy regimen demonstrated higher median progression-free survival in advanced NSCLC patients and did not adversely affect QoL.