Cancer Res Treat.  2011 Dec;43(4):217-224.

Gemcitabine Plus Platinum Combination Chemotherapy for Elderly Patients with Advanced Non-small Cell Lung Cancer: A Retrospective Analysis

• Chun SH
• Lee JE
• Park MH
• Kang JH
• Kim YK
• Wang YP
• Park JK
• Kim HK

Abstract

PURPOSE
This study aimed to analyze the efficacy and toxicity of gemcitabine plus platinum chemotherapy for patients aged 70 years or older with advanced non-small-cell lung cancer (NSCLC).
MATERIALS AND METHODS
We reviewed the records of stage IIIB, IV NSCLC patients or surgically inoperable stage II, IIIA NSCLC patients who were aged 70 years or older when treated with gemcitabine (1,250 mg/m2) plus cisplatin (75 mg/m2) or carboplatin (AUC5) chemotherapy from 2001 to 2010 at Seoul St. Mary's Hospital, Uijeongbu St. Mary's Hospital and St. Vincent's Hospital. Gemcitabine was administered on days 1 and 8, and cisplatin or carboplatin was administered on day 1. Treatments were repeated every 3 weeks for a maximum of 4 cycles.
RESULTS
The median age of the 62 patients was 73.5 years (range, 70 to 84 years). Forty-one (66%) patients exhibited comorbidity. The mean number of treatment cycles was 3.9. The compared average relative dose intensity of gemcitabine plus platinum chemotherapy was 84.8%. The median progression-free survival and overall survival (OS) were 5.0 months and 9.4 months, respectively. Reduced Eastern Cooperative Oncology Group (ECOG) performance status (none vs. > or =1) and weight loss (<5% vs. > or =5%) after treatment were found to have a significant effect on OS (p=0.01).
CONCLUSION
Gemcitabine plus platinum chemotherapy is an effective treatment option with an acceptable level of toxicity in patients aged 70 years or older with good performance status in advanced NSCLC.

Keyword

Non-small-cell lung carcinoma; Aged; Gemcitabine; Platinum; Drug therapy

MeSH Terms

Aged
Carboplatin
Carcinoma, Non-Small-Cell Lung
Cisplatin
Comorbidity
Deoxycytidine
Disease-Free Survival
Drug Therapy, Combination
Humans
Lung
Lung Neoplasms
Platinum
Retrospective Studies
Weight Loss
Carboplatin
Cisplatin
Deoxycytidine
Platinum

Figure

• 

  Fig. 1 (A) Overall survival of all patients in this study. (B) Overall survival for 70-74 year-olds compared with older than 75 year-olds.

• 

  Fig. 2 (A) Progression-free survival of all patients in this study. (B) Progression-free survival for 70-74 year-olds compared with older than 75 year-olds.

Reference

1. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011; 43:1–11. PMID: 21509157.

2. Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003; 21:1383–1389. PMID: 12663731.

3. Hurria A. Clinical trials in older adults with cancer: past and future. Oncology (Williston Park). 2007; 21:351–358. PMID: 17447438.

4. Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J. 2005; 11:449–460. PMID: 16393479.

5. Ferrari AU, Radaelli A, Centola M. Invited review: aging and the cardiovascular system. J Appl Physiol. 2003; 95:2591–2597. PMID: 14600164.

6. Chatelut E, Canal P, Brunner V, Chevreau C, Pujol A, Boneu A, et al. Prediction of carboplatin clearance from standard morphological and biological patient characteristics. J Natl Cancer Inst. 1995; 87:573–580. PMID: 7752255.

7. Natale RB. Gemcitabine-containing regimens vs others in first-line treatment of NSCLC. Oncology (Williston Park). 2004; 18(8 Suppl 5):27–31. PMID: 15339056.

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

9. Berardi R, Porfiri E, Scartozzi M, Lippe P, Silva RR, Nacciarriti D, et al. Elderly patients with advanced non-small cell lung cancer. A pase II study with weekly cisplatin and gemcitabine. Oncology. 2003; 65:198–203. PMID: 14657592.

10. Feliu J, Martín G, Madroñal C, Rodríguez-Jaráiz A, Castro J, Rodríguez A, et al. Combination of low-dose cisplatin and gemcitabine for treatment of elderly patients with advanced non-small-cell lung cancer. Cancer Chemother Pharmacol. 2003; 52:247–252. PMID: 12783203.

11. Minami H, Ohe Y, Niho S, Goto K, Ohmatsu H, Kubota K, et al. Comparison of pharmacokinetics and pharmacodynamics of docetaxel and Cisplatin in elderly and non-elderly patients: why is toxicity increased in elderly patients? J Clin Oncol. 2004; 22:2901–2908. PMID: 15254059.

12. Kubota K, Furuse K, Kawahara M, Kodama N, Ogawara M, Takada M, et al. Cisplatin-based combination chemotherapy for elderly patients with non-small-cell lung cancer. Cancer Chemother Pharmacol. 1997; 40:469–474. PMID: 9332460.

13. Langer CJ, Manola J, Bernardo P, Kugler JW, Bonomi P, Cella D, et al. Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst. 2002; 94:173–181. PMID: 11830607.

14. Gridelli C. The ELVIS trial: a phase III study of single-agent vinorelbine as first-line treatment in elderly patients with advanced non-small cell lung cancer. Elderly Lung Cancer Vinorelbine Italian Study. Oncologist. 2001; 6(Suppl 1):4–7. PMID: 11181997.

15. Frasci G, Lorusso V, Panza N, Comella P, Nicolella G, Bianco A, et al. A Southern Italy Cooperative Oncology Group (SICOG) phase III trial. Gemcitabine plus vinorelbine yields better survival outcome than vinorelbine alone in elderly patients with advanced non-small cell lung cancer. Lung Cancer. 2001; 34(Suppl 4):S65–S69. PMID: 11742706.

16. Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, et al. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003; 95:362–372. PMID: 12618501.

17. Davidoff AJ, Tang M, Seal B, Edelman MJ. Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol. 2010; 28:2191–2197. PMID: 20351329.

18. Quoix EA, Oster J, Westeel V, Pichon E, Zalcman G, Baudrin L, et al. Weekly paclitaxel combined with monthly carboplatin versus single-agent therapy in patients age 70 to 89: IFCT-0501 randomized phase III study in advanced non-small cell lung cancer (NSCLC). J Clin Oncol. 2010; 28(18S):2.