Lung cancer, as the leading cause of death in oncology is one of the most challenging diseases nowadays. Even after the implementation of checkpoint inhibitors and targeted therapy as a standard of therapy for metastatic disease, the chemotherapy backbone remains essential in the treatment of these patients. This study aimed to evaluate how administration particularities in chemotherapy and toxicity management can influence the outcome. We conducted a retrospective single-institution study, at Elias University Emergency Hospital, Bucharest, Romania, between 2014 and 2018, in a heterogeneous patient population with metastatic non-small cell lung cancer that received combination chemotherapy. The inclusion criteria for this trial were—histological proof of non-small cell lung cancer (NSCLC), stage IV disease, ECOG (Eastern Cooperative Oncology Group) performance status of a maximum of two, treatment with cytotoxic chemotherapy for at least four courses (patients with fewer courses were excluded). All patients received combination chemotherapy. The main focus was on the effect of dose reduction and treatment delay on overall survival and progression-free survival. A total of 129 patients were enrolled. The response rate in the studied population was 69% and 62.8% had no toxicity greater than grade 2. Chemotherapy regimens used had the following distribution—paclitaxel + carboplatin 41.9%, paclitaxel + carboplatin + bevacizumab 12.4%, pemetrexed + carboplatin 12.4%, gemcitabine + carboplatin 26.4% and other regimens 7%. Mean PFS (Progression Free Survival) was 9.1 months and the mean OS (Overall Survival) was 14 months. OS was not significantly different in the treatment delay group versus the no delay one, p < 0.25 but dose- reduction significantly impacted OS, p < 0.03. Administration particularities, like febrile neutropenia prophylaxis, treatment of chemotherapy-related anemia, respecting the details of chemostability and preparation rules and emesis prophylaxis, were considered reasons for the good outcome. Details regarding cytotoxic chemotherapy administration remain of paramount importance for a good outcome and the benefit for survival they convey is crucial. Sometimes the benefit the patient derives from these details is comparable to the one newer therapies convey.

中文翻译：

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在非小细胞肺癌中进行细胞毒性化疗时剂量强度的重要性-与以往一样，现在也是如此

作为肿瘤死亡的主要原因，肺癌是当今最具挑战性的疾病之一。即使在实施检查点抑制剂和靶向治疗作为转移性疾病治疗的标准之后，化学疗法的骨干结构仍对这些患者的治疗至关重要。这项研究旨在评估化学疗法和毒性管理中的管理特殊性如何影响结果。我们于2014年至2018年间在罗马尼亚布加勒斯特的伊莱亚斯大学急诊医院进行了一项回顾性单机构研究，研究对象是接受联合化疗的转移性非小细胞肺癌患者。该试验的纳入标准为：非小细胞肺癌（NSCLC）的组织学证明，IV期疾病，ECOG（东部合作肿瘤小组）的表现状态最多为两个，至少有四个疗程用细胞毒性化学疗法治疗（排除了较少疗程的患者）。所有患者均接受联合化疗。主要关注剂量减少和治疗延迟对总体生存和无进展生存的影响。共有129名患者入组。在研究的人群中，有效率为69％，有62.8％的毒性没有大于2级。所用化学疗法的分布如下：紫杉醇+卡铂41.9％，紫杉醇+卡铂+贝伐单抗12.4％，培美曲塞+卡铂12.4％，吉西他滨+卡铂26.4％，其他方案7％。平均PFS（无进展生存期）为9.1个月，平均OS（总体生存期）为14个月。p <0.25，但剂量降低显着影响OS，p <0.03。诸如发热性中性粒细胞减少症的预防，化疗相关性贫血的治疗，尊重化学稳定性和制备规则以及呕吐的预防等给药方式被认为是取得良好结果的原因。有关细胞毒性化学疗法管理的细节对于获得良好的结果仍然至关重要，而它们所传达的生存益处至关重要。有时，患者从这些细节中获得的益处可与一种较新的疗法相媲美。