Chemotherapy Combination Improves Survival in Elderly Lung Cancer Patients
Survival can be improved in older patients with advanced non-small cell lung cancer (NSCLC) with the use of two chemotherapy drugs as opposed to a single agent, French researchers reported Sunday June 6, 2010, at the American Society of Clinical Oncology (ASCO) annual meeting. The findings come from a phase III clinical trial of 451 patients between the ages of 70 and 89, the first lung cancer trial to enroll strictly older patients. The trial was stopped early when an interim analysis showed a more than 4-month improvement in overall survival in patients receiving the chemotherapy “doublet” of carboplatin (Paraplatin) and paclitaxel (Taxol) compared with those receiving single-agent treatment with either gemcitabine (Gemzar) or vinorelbine (Navelbine).
In addition to improved overall survival, patients in the trial who were randomly assigned to receive both chemotherapy drugs had longer progression-free survival and higher tumor response rates than patients who received single-agent treatment, reported the trial’s lead investigator, Elisabeth Quoix, M.D., of University Hospital in Strasbourg, France. The beneficial effect was seen “in most subgroups tested,” she explained during a press briefing, including patients with a poorer prognosis, such as smokers and those of more advanced age.
When the trial was launched in 2005, ASCO clinical guidelines recommended single-agent chemotherapy to treat advanced lung cancer in older patients, Dr. Quoix noted. These new findings establish “a new [treatment] paradigm for elderly patients with NSCLC,” she said.
Median overall survival in the combination therapy arm was 10.4 months, compared with 6.2 months in patients who received a single agent. One-year survival was 45 percent and 27 percent, respectively. The combination therapy was, however, associated with greater side effects, including a nearly fourfold increase in neutropenia, a dangerous decline of white blood cells.
According to a recent study, most elderly patients with advanced NSCLC don’t receive any chemotherapy, and those who do usually receive only single-agent therapy, explained Martin Edelman, M.D., of the University of Maryland Greenebaum Cancer Center, during the plenary session presentation of the trial results. Dr. Edelman noted some concerns about the trial design, including the combination regimen that was chosen and its dosing schedule. Nevertheless, he continued, data from this trial and other clinical trials support the benefit of platinum-based combination chemotherapy in elderly patients and “should change day-to-day practice.”
Mark Kris, M.D., chief of the Thoracic Oncology Service at Memorial Sloan-Kettering Cancer Center, agreed. “Patients over the age of 70 should be treated just like anyone else,” Dr. Kris said during a press briefing, with therapy decisions guided by factors such as comorbidities and patient preference, among others.
The results of the trial were published online August 9, 2011, in The Lancet (see the journal abstract).