Survival Analysis and Clinical Outcomes between Paclitaxel and Carboplatin Versus Carboplatin and Gemcitabine in Patients with Advanced-stage Non-small-cell Lung Cancer: A Single-center Cohort Study

BACKGROUND: Palliative chemotherapy using platinum-based doublet chemotherapy was recommended as one of the standard treatments in patients with advanced-stage non-small cell lung cancer (NSCLC) with negative EGFR mutation. This study aimed to compare clinical outcomes between patients treated with paclitaxel and carboplatin (PC) and those treated with carboplatin and gemcitabine (CG). METHODS: We conducted a retrospective cohort study comparing PC and CG at Hatyai Hospital between 2012 and 2019. The primary outcome was survival analysis, and the secondary outcome was chemotherapy-related adverse events, and the rate and reason for stopping chemotherapy. RESULT: The median overall survivals of both groups was comparable (9.0 months for the PC group and 9.6 months for the CG group; log-rank, p=0.287). The CG group had a higher incidence of adverse events (89.7% vs. 77.9%, p=0.010) and tended to have a lower rate of chemotherapy discontinuation (29.6% vs. 41.2%, p=0.080) than the PC group. In the multivariate analysis, female sex (odds ratio [OR]=0.351; 95% confidence interval [CI], 0.158-0.780; p=0.010) and higher performance status (OR=76.374; 95%CI, 32.533-179.295; p<0.001) were independent predictive factors for stopping chemotherapy. In the proportional hazards model, the factors associated with decreased survival included higher performance status (hazard ratio [HR]=1.939; 95%CI, 1.388-2.709; P<0.001) and discontinuation of chemotherapy (HR=2.572; 95%CI, 1.792-3.691; p=<0.001). CONCLUSION: These two platinum-based regimens had comparable effects on overall survival. The CG group had a higher incidence of chemotherapy-related adverse events, while the PC group had a marginally significantly higher rate of stopping chemotherapy from unacceptable adverse events and deterioration of patients’ clinical status.