# Concurrent Chemoradiotherapy with Daily Low-Dose Carboplatin in Older Patients with Unresectable Locally Advanced Non-Small-Cell Lung Cancer: Clinical Outcomes and Prognostic Significance of Systemic Inflammation Markers

## TL;DR

A study in Japan found that older patients with advanced lung cancer benefit from chemoradiotherapy with low-dose carboplatin, and a blood-based inflammation score helps predict survival.

## Contribution

The Glasgow Prognostic Score is identified as a novel, practical predictor of survival in older NSCLC patients undergoing chemoradiotherapy.

## Key findings

- Daily low-dose carboplatin chemoradiotherapy provided durable disease control with acceptable toxicity in older NSCLC patients.
- The Glasgow Prognostic Score (GPS) was an independent predictor of progression-free survival and a significant indicator of overall survival.
- GPS outperformed other inflammation-based indices in predicting prognosis.

## Abstract

In Japan, older patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) are commonly treated with concurrent chemoradiotherapy using daily low-dose carboplatin; however, evidence from real-world practice remains limited. In this multicenter retrospective study, we evaluated long-term clinical outcomes, safety, and prognostic significance of systemic inflammation markers in patients treated with this regimen. Among 52 older patients, chemoradiotherapy achieved durable disease control with acceptable toxicity. Notably, the Glasgow Prognostic Score (GPS), calculated from routinely measured C-reactive protein and albumin levels, emerged as a simple and objective predictor of progression-free survival, outperforming other inflammation-based indices. These findings suggest that daily low-dose carboplatin chemoradiotherapy is a feasible and effective option for older patients and that the GPS may serve as a practical tool for pretreatment risk stratification and individualized treatment planning in routine clinical practice.

Older patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) frequently receive concurrent chemoradiotherapy (CCRT) with daily low-dose carboplatin; however, real-world data on its efficacy, safety, and prognostic factors remain limited. We aimed to retrospectively evaluate the clinical outcomes of this regimen and examined whether systemic inflammation-based indices predict prognosis in this setting. We reviewed 52 consecutive patients with locally advanced NSCLC treated with first-line CCRT using daily low-dose carboplatin at three Japanese institutions between April 2007 and December 2019. The median progression-free survival (PFS) and overall survival (OS) were 11.5 and 40.1 months, respectively. Twenty patients received durvalumab as consolidation therapy. In the overall cohort, multivariate analysis identified the Glasgow Prognostic Score (GPS) as an independent predictor of PFS. A GPS of 0–1 was also associated with a significantly longer OS in univariate analysis. CCRT with daily low-dose carboplatin provided durable disease control with acceptable toxicity in older patients with unresectable stage II/III NSCLC. The GPS appears to be a simple marker for PFS in this population and may aid in pretreatment risk stratification alongside histology and consolidation strategies.