Response to cytostatic treatment in inoperable adenocarcinoma of the lung: critical implications

The prognostic factors for response to chemotherapy and the prognostic impact of response status on survival, relative to other prognostic variables, were evaluated among 53 responding (9 complete responses; 44 partial responses) and 165 non-responding patients with inoperable adenocarcinoma of the lung (ACL). Multiple logistic regression analysis, including 27 pretreatment variables, revealed that the only significant predictor of response was bidimensionally measurable disease parameter (P = 0.02), followed by brain metastases that were negatively correlated to response, although insignificantly (P = 0.10). Univariate landmark analyses among patients alive at 8, 12, 16 and 24 weeks showed a trend towards better survival for responders compared with non-responders, but did not reach a significant level at any time (P values 0.78, 0.57, 0.23 and 0.12, respectively). Death hazard ratios for responders to non-responders were 0.91, 0.89, 0.79 and 0.73. Multivariate regression analysis among patients alive at 16 weeks demonstrated a significant impact on survival for performance status, non-radical tumour resection, liver metastases and LDH, while the impact of response status in comparison was weak and insignificant. This reflects the unsatisfactory treatment results achieved in inoperable ACL, with the majority of responses being partial, and calls for improvement of the cytostatic treatment currently available.