Survival Benefits of Platinum-Based Doublet Chemotherapy in Elderly Patients With NSCLC

In a multicenter, open-label, randomized phase III trial, Quoix and colleagues compared a carboplatin and paclitaxel doublet chemotherapy regimen with monotherapy in elderly patients with advanced non–small-cell lung cancer (NSCLC). A total of 451 patients between ages 70 and 89 years with locally advanced or metastatic NSCLC and World Health Organization performance status scores of 0–2 were enrolled. There were 226 patients who received 5 cycles (2 weeks on treatment, 1 week off treatment) of vinorelbine or gemcitabine monotherapy. Doublet chemotherapy, consisting of 4 cycles (3 weeks on treatment, 1 week off treatment) of carboplatin (on day 1) plus paclitaxel (on days 1, 8, and 15) was administered in 225 patients. The median overall survival was 10.3 months among patients treated with combination chemotherapy and 6.2 months among patients treated with monotherapy (hazard ratio [HR] 0.64; 95% confidence interval [CI], 0.52–0.78; P<.0001). The 1-year survival was 44.5% (95% CI, 37.9–50.9%) in the doublet chemotherapy arm and 25.4% (95% CI, 19.9–31.3%) in the monotherapy arm. Toxicities occurred more frequently in the doublet chemotherapy arm versus the monotherapy arm, including decreased neutrophil count (48.4% vs 12.4%, respectively) and asthenia (10.3% vs 5.8%, respectively). The study was published in the September issue of The Lancet. Despite the increased toxicities of platinum-based doublet chemotherapy, the results suggest that elderly patients with advanced NSCLC can be considered for the same aggressive therapy as younger patients; additional research is warranted.

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