A combination of two common chemotherapy agents increases survival in patients with advanced non-small cell lung cancer (NSCLC) aged 70 and above, a study says.
Elderly patients (those aged between 70 and 89) with advanced NSCLC who were given paclitaxel and carboplatin were shown to have significant increases in both overall and progression-free survival compared to patients who were on standard single agent therapy (those given either gemcitabine or vinorelbine).
“Elderly patients are often not given aggressive treatment out of concern that they will not be able to tolerate it. These results demonstrate that a more intensive regimen given to younger patients can be effective and tolerable in this group,” said lead author Dr. Elisabeth Quoix, who is also a professor of medicine at University Hospital in Strasbourg, France.
This phase III randomized trial examined 451 patients with advanced NSCLC (stage III or IV) at 62 international centers between 2005 and 2009. Initially, the study was supposed to include 520 patients, but was stopped early when an interim analysis found that overall survival was longer in the combination group (median survival time = 10.4 months) compared to those receiving single-agent therapy (median survival time = 6.2 months).
One-year survival in patients on doublet therapy was 45.1 percent (95% CI 38.2-51.
whilst 1-year survival of patients on single-agent therapy was 26.9 percent (95% CI 21-33.1). Furthermore, patients receiving combination therapy were found to live nearly twice as long (6.3 months) as those who were on single-agent therapy (3.2 months) before their lung cancer progressed.
“Carboplatin-based doublet had a beneficial effect on survival in most of the subgroups tested, even those of lower prognosis such as older age, smokers and those with lower activity daily living (ADL) scores (a geriatric index),” said Quoix. “The new paradigm for elderly patients with advanced NSCLC is to use chemotherapy – monthly carboplatin with weekly paclitaxel.”
As for toxicity, despite the fact that combination therapy had acceptable toxicity, preliminary data in 313 patients found that patients in the combination regimen experienced moderate-to-severe neutropenia more frequently than the single-drug group (47.8 percent vs. 12.2 percent).
Standard treatment for elderly patients with advanced NSCLC is single-drug therapy. However, this recommendation is based on older studies. Few new clinical trials evaluate lung cancer therapies in the elderly, despite the fact that more than one half of patients with NSCLC are at least 65-years-old, and at least 30 percent of all NSCLC patients are aged 70 years or older.
Nevertheless, the combination regimen evaluated in this trial, which was conducted by the French Intergroup of Thoracic Oncology (IFCT), has been proven more effective in another phase III trial that did not control for age, although a subgroup analysis suggested that the regimen would also be effective in treating patients aged 70 or older.
“Lung cancer is increasing in elderly patients due to an increase in life expectancy,” said Quoix at a press conference. “So it is a matter of public health to treat elderly patients, who until now, have been quite neglected.”
Commenting on the study, Dr. Mark G. Kris, medical oncologist and chief of the Thoracic Oncology Service at the Memorial Sloan-Kettering Cancer Center, New York, US, noted that the revised 2009 ASCO guidelines, which concluded that age, per se, should not be used as a criteria to use chemotherapy, was completely supported by the trial presented by Quoix.
“People over the age of 70 should be treated just like anyone else,” he said.
Source: mims.com
