Cancer Res Treat.  2008 Sep;40(3):116-120.

Gemcitabine and Carboplatin Combination Chemotherapy for Elderly Patients with Advanced Non-small Cell Lung Cancer: A Feasibility Study

• Yuh YJ
• Lee HR
• Kim SR

Abstract

PURPOSE
Although platinum based chemotherapy is known to improve the survival duration for the patients with non-small cell lung cancer, the role of platinum for elderly patient is not yet clear. We administered gemcitabine and carboplatin combination therapy to elderly patients with NSCLC. The aim of this study was to evaluate the efficacy and toxicities of this regimen for elderly patients.
MATERIALS AND METHODS
The eligibility criteria were as follows: pathologically confirmed NSCLC, an age > or = 65 years, advanced disease with stage IIIB or IV and the patients were chemotherapy-naive. The treatment regimen was as follows; gemcitabine 1,000 mg/m2 was administered on days 1 and 8 and carboplatin AUC=5 was administered on day 1. This regimen was repeated every 3 weeks. The efficacy was evaluated in terms of the response rate, the time to progression and the overall survival duration.
RESULTS
From Dec 2001 to Feb 2005, a total of 20 pa-tients were entered into this study. The median patient age was 68 years (range: 65~75). 19 patients were evaluable for their treatment response. A partial response was obtained in 8 patients (response rate: 42.1%, 95% CI: 19.4~64.8%). The median time to progression and the survival duration were 136 days and 453 days, respectively. Among a total of 65 cycles of treatment, grade 3 or 4 leukopenia and thrombocytopenia were observed in 7.7% and 13.9% of the cycles, respectively. Grade 3 or 4 vomiting was observed in 7.7% of the cycles. Grade 3 skin rash developed in 1.5% of the cycles. 1 patient died of septic shock after chemotherapy.
CONCLUSIONS
Gemcitabine and carboplatin combination chemotherapy was relatively safe and effective for treating elderly patients with NSCLC.

Keyword

Gemcitabine; Carboplatin; Non-small cell lung cancer; Aged

MeSH Terms

Aged
Carboplatin
Carcinoma, Non-Small-Cell Lung
Deoxycytidine
Drug Therapy, Combination
Exanthema
Feasibility Studies
Humans
Leukopenia
Lung
Platinum
Shock, Septic
Thrombocytopenia
Vomiting
Carboplatin
Deoxycytidine
Platinum

Figure

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  Fig. 1 Time to progression.

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  Fig. 2 Overall survival.

Reference

1. Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol. 2001; 2:533–543. PMID: 11905707.

2. Kim SY, Ryoo HM, Bae SH, Kim KC, Hyun DS, Lee SC, et al. Efficacy of administration of weekly docetaxel combined with platinum as a first-line treatment for patients with advanced non-small cell lung cancer. Korea J Med. 2007; 72:625–631.

3. Gridelli C, Perrone F, Monfardini S. Lung cancer in the elderly. Eur J Cancer. 1997; 33:2313–2314. PMID: 9616273.

4. Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995; 311:899–909. PMID: 7580546.

5. Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999; 341:2061–2067. PMID: 10615079.

6. The Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 1999; 91:66–72. PMID: 9890172.

7. Earle CC, Tsai JS, Gelber RD, Weinstein MC, Neumann PJ, Weeks JC. Effectiveness of chemotherapy for advanced lung cancer in the elderly: instrumental variable and propensity analysis. J Clin Oncol. 2001; 19:1064–1070. PMID: 11181670.

8. Ricci S, Antonuzzo A, Galli L, Tibaldi C, Bertuccelli M, Lopes Pegna A, et al. Gemcitabine monotherapy in elderly patients with advanced non-small cell lung cancer: a multicenter phase II study. Lung Cancer. 2000; 27:75–80. PMID: 10688490.

9. Bianco V, Rozzi A, Tonini G, Santini D, Magnolfi E, Vincenzi B, et al. Gemcitabine as single agent chemotherapy in elderly patients with stages III-IV non-small cell lung cancer (NSCLC): a phase II study. Anticancer Res. 2002; 22:3053–3056. PMID: 12530041.

10. Klastersky J, Sculier JP, Lacroix H, Dabouis G, Bureau G, Libert P, et al. A randomized study comparing cisplatin or carboplatin with etoposide in patients with advanced non-small-cell lung cancer: European Organization for Research and Treatment of Cancer Protocol 07861. J Clin Oncol. 1990; 8:1556–1562. PMID: 2167953.

11. Sederholm C, Hillerdal G, Lamberg K, Kolbeck K, Dufmats M, Westberg R, et al. Phase III trial of gemcitabine plus carboplatin versus single-agent gemcitabine in the treatment of locally advanced or metastatic non-small-cell lung cancer: the Swedish Lung Cancer Study Group. J Clin Oncol. 2005; 23:8380–8388. PMID: 16293868.

12. Masters GA, Argiris AE, Hahn EA, Beck JT, Rausch PG, Ye Z, et al. A randomized phase II trial using two different treatment schedules of gemcitabine and carboplatin in patients with advanced non-small-cell lung cancer. J Thorac Oncol. 2006; 1:19–24. PMID: 17409822.

13. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002; 346:92–98. PMID: 11784875.

14. Iaffaioli RV, Tortoriello A, Facchini G. Phase I-II study of gemcitabine and carboplatin in Stage IIIB-IV non-small cell lung cancer. J Clin Oncol. 1999; 17:921–926. PMID: 10071285.

15. Rinaldi M, Crino L, Scagliotti GV, Mosconi AM, De Marinis F, Gridelli C, et al. A three-week schedule of gemcitabine-cisplatin in advanced non-small-cell lung cancer with two different cisplatin dose levels: a phase II randomized trial. Ann Oncol. 2000; 11:1295–1300. PMID: 11106119.

16. Cardenal F, Lopez-Cabrerizo MP, Anton A, Alberola V, Massuti B, Carrato A, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 1999; 17:12–18. PMID: 10458212.

17. Mazzanti P, Massacesi C, Rocchi MB, Mattioli R, Lippe P, Trivisonne R, et al. Randomized, multicenter, phase II study of gemcitabine plus cisplatin versus gemcitabine plus carboplatin in patients with advanced non-small cell lung cancer. Lung Cancer. 2003; 41:81–89. PMID: 12826316.

18. Go RS, Adjei AA. Review of the comparative pharmacology and clinical activity of cisplatin and carboplatin. J Clin Oncol. 1999; 17:409–422. PMID: 10458260.

19. Hainsworth JD, Burris HA 3rd, Litchy S, Morrissey LH, Barton JH, Bradof JE, et al. Weekly docetaxel in the treatment of elderly patients with advanced nonsmall cell lung carcinoma. Cancer. 2000; 89:328–333. PMID: 10918162.

20. Gridelli C, Aapro M, Ardizzoni A, Balducci L, De Marinis F, Kelly K, et al. Treatment of advanced non-small-cell lung cancer in the elderly: results of an international expert panel. J Clin Oncol. 2005; 23:3125–3137. PMID: 15860872.

21. Gridelli C, Aapro M, Ardizzoni A, Balducci L, De Marinis F, Kelly K, et al. Treatment of advanced non-small-cell lung cancer in the elderly: results of an international expert panel. J Clin Oncol. 2005; 23:3125–3137. PMID: 15860872.