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ORIGINAL ARTICLE
Year : 2017  |  Volume : 54  |  Issue : 1  |  Page : 161-163
 

Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy


1 Department of Medical Oncology, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Medical Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Dr. K Udupa
Department of Medical Oncology, Kasturba Medical College, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.219558

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 » Abstract 

INTRODUCTION: Lung cancer is most common cause of cancer death in the world. Most of the patient are diagnosed in the late stages and receive only palliative treatment. The main objective of the palliative chemotherapy is to improve survival as well as the quality of life (QOL). QOL is the most neglected dimension of cancer care in developing countries like India. Palliative chemotherapeutic agent which has minimum toxicity and prolongs the survival of metastatic cancer patients is the need of the day. MATERIALS AND METHODS: In this study, 43 metastatic adenocarcinoma of lung patients of South Indian origin were enrolled. Twenty patients out of this 43 were epidermal growth factor receptor (EGFR) mutation positive and were started on tyrosine kinase inhibitor (TKI). Rest 23 patients were EGFR mutation negative and were started on various platinum-based doublet chemotherapy. QOL was measured using Cancer Institute QOL Questionnaire version 2 at the beginning of therapy and at the end of 3 months. RESULTS: Our study showed that metastatic lung cancer patients had average QOL at presentation. The QOL in patients on TKI improved compared to those on platinum doublet chemotherapy during the second assessment, but this improvement was statistically not significant. CONCLUSION: In this study, the metastatic lung cancer patients had an average QOL during initial presentation. Patients on TKI had a trend toward better QOL after 3 months of treatment compared to platinum doublet chemotherapy.


Keywords: Platinum doublet chemotherapy, quality of life, tyrosine kinase inhibitor


How to cite this article:
Udupa K, Rajendranath R, Sagar T G. Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy. Indian J Cancer 2017;54:161-3

How to cite this URL:
Udupa K, Rajendranath R, Sagar T G. Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy. Indian J Cancer [serial online] 2017 [cited 2020 Mar 29];54:161-3. Available from: http://www.indianjcancer.com/text.asp?2017/54/1/161/219558



 » Introduction Top


Lung cancer is the most common cancer in the world and most common cause of cancer death.[1] Most of the lung cancer are diagnosed in the advanced stage, and more than 80% of the patients die within 1 year of diagnosis.[2] Advanced and metastatic lung cancer is treated with palliative chemotherapy, and the main aim of this type treatment is to prolong the life and to improve the quality of life (QOL).[3]

QOL is an important dimension in cancer which has been largely neglected in many of the developing countries like India. Hardly, there are any data regarding the QOL among advanced lung cancer patients from the Indian subcontinent. Palliative chemotherapeutic agents which prolong the survival, which has least side effects and most importantly which improve the QOL of these advanced metastatic patients are of great relevance.

Many studies have shown that palliative chemotherapy has improved QOL in advanced carcinoma lung compared to best supportive care.[4] However, there are limited data to address which chemotherapy agent has given best QOL in these patients.

In this study, we compared QOL in metastatic lung cancer patients who were treated with tyrosine kinase inhibitors (TKIs) (which is given in the oral form) and platinum doublet chemotherapy (which is given in intravenous form).


 » Materials and Methods Top


This was a prospective nonrandomized study conducted in Cancer Institute, Adyar, Chennai where 43 metastatic adenocarcinoma of lung patients of South Indian origin were enrolled. Twenty patients were epidermal growth factor receptor (EGFR) mutation positive (which was tested using scorpion probe-based amplification refractory mutation system-polymerase chain reaction technique in Triesta Lab, Bengaluru, Karnataka, India) and were started on TKI. Rest 23 patients were EGFR mutation negative and were started on various platinum-based doublet chemotherapy.

The QOL was assessed using standardized Cancer Institute-QOL Questionnaire (CI-QOL-Q) version 2.[5] This is a modified version of the European Organization for Research and Treatment of Cancer QOL (EORTC QOL) 30 questionnaire and has 41 questions that has been standardized for the Indian population. This mainly assesses the QOL in 11 dimensions, which includes general well-being, physical well-being, psychological well-being, interpersonal relationship, sexual and personal ability, cognitive well-being, optimism and belief, economical well-being, informational support, patient-physician relationship and body image.

The norms of QOL scale version 2 is shown in [Table 1].
Table 1: The norms of CI-QOL-Q scale version 2

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The QOL was assessed at baseline and was compared to the QOL at 3 months for patients on TKI and chemotherapy.


 » Results Top


The demographic profile of the patients enrolled in our study is shown in [Table 2]. Forty-three patients completed both baseline and second assessment which was 3 months after starting the treatment. The CI-QOL scores are shown in [Table 3].
Table 2: Demographic profile of the patients enrolled in study

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Table 3: Comparison table of overall QOL between baseline and 2nd assessment

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The mean average score at baseline was 128 and that at second assessment was 126. This indicates that the lung cancer in our study had average QOL, and their QOL did not change significantly during their second assessment.

Among the 43 patients, 20 patients were on TKI (15 patients on gefitinib and 5 patients on erlotinib) and the remaining 23 were on chemotherapy. The various chemotherapy regimens prescribed in shown in [Table 4]. The QOL comparison between TKI arm and chemotherapy arm between baseline and second assessment is shown in [Table 5]. The mean score in patients on TKI and chemotherapy was same at baseline, but during second assessment TKI patients had better QOL compared to patients on chemotherapy, but this improvement was not statistically significant (P = 0.126). The dimensions physical well-being, as well as optimism and belief, showed significant improvement in the TKI group compared to chemotherapy group.
Table 4: Chemotherapy regimens used in the study

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Table 5: Comparison table of QOL between TKI and chemotherapy arms between 1st and 2nd assessment

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The important toxicity in TKI arm was skin toxicity and diarrhea whereas the important toxicity in chemotherapy arm was vomiting, neutropenia, and fatigue.


 » Discussion Top


QOL in lung cancer patients is usually measured using Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire, Lung Cancer Symptom Scale, EORTC QOL - lung cancer 13 questionnaire.[6] However, these questionnaires are not standardized for Indian patient, and we require to have our own method to assess QOL in our subset of patients.

There are limited data from India where QOL has been measured using questionnaire standardized for Indian patients. In this study, we used CI-QOL-Q, which has been standardized for Indian patients.[5]

At presentation, our study population had average QOL with score of 128. After treatment patients who were EGFR positive and started on TKI had better QOL compared to patients who were EGFR negative and started on chemotherapy (mean QOL score of 122.22 vs. 132.83) even though it was statistically nonsignificant.

Similar to our study, in OPTIMAL trial which assessed QOL using FACT-L, Trial Outcome Index, Lung Cancer Subscale questionnaire had significant improvement in QOL with TKI compared to chemotherapy arm. In IPASS study health-related QOL was better in TKI arm in patients who were EGFR positive, and in chemotherapy arm in patients who are EGFR negative.[7],[8]

To the best of our knowledge, this is the first study from India where QOL questionnaire which is standardized for Indian patients was used to compare the QOL between TKI and platinum doublet chemotherapy in patients suffering from advanced lung cancer. However, a much larger randomized control study from India with longer follow-up is required to prove our hypothesis that patients on TKI chemotherapy have better QOL compared to platinum doublet chemotherapy in our subset of population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

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Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.  Back to cited text no. 1
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Martini N. Operable lung cancer. CA Cancer J Clin 1993;43:201-14.  Back to cited text no. 2
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Montazeri A, Gillis CR, McEwen J. Quality of life in patients with lung cancer: A review of literature from 1970 to 1995. Chest 1998;113:467-81.  Back to cited text no. 3
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Pat K, Dooms C, Vansteenkiste J. Systematic review of symptom control and quality of life in studies on chemotherapy for advanced non-small cell lung cancer: How CONSORTed are the data? Lung Cancer 2008;62:126-38.  Back to cited text no. 4
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Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer – Indian scenario. Indian J Cancer 2005;42:138-44.  Back to cited text no. 5
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6.
Anant M, Guleria R, Pathak AK, Bhutani M, Pal H, Charu M, et al. Quality of life measures in lung cancer. Indian J Cancer 2005;42:125-32.  Back to cited text no. 6
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Thongprasert S, Duffield E, Saijo N, Wu YL, Yang JC, Chu DT, et al. Health-related quality-of-life in a randomized phase III first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients from Asia with advanced NSCLC (IPASS). J Thorac Oncol 2011;6:1872-80.  Back to cited text no. 7
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8.
Chen G, Feng J, Zhou C, Wu YL, Liu XQ, Wang C, et al. Quality of life (QoL) analyses from OPTIMAL (CTONG-0802), a phase III, randomised, open-label study of first-line erlotinib versus chemotherapy in patients with advanced EGFR mutation-positive non-small-cell lung cancer (NSCLC). Ann Oncol 2013;24:1615-22.  Back to cited text no. 8
[PUBMED]    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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