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Combination Therapy Safe and Effective for Older Patients With Lung Cancer
"Aggressive chemotherapy regimens are often avoided in older patients with advanced lung cancer due to concerns about toxic effects associated with the treatment," said Dr. Belani, also co-director of the Lung Cancer Program at UPCI. "Old age should not be a deterrent to prescribing the most appropriate and effective treatment for advanced lung cancer as demonstrated clearly in this study."
Of the 403 patients in the multicenter study, 111 patients age 70 and older with advanced NSCLC were randomized into three treatment arms that received different schedules of weekly paclitaxel in combination with carboplatin. Patients on the first arm received carboplatin (AUC=6) every four weeks in combination with paclitaxel (100mg/m2) administered weekly for three out of four weeks. The second arm consisted of weekly carboplatin (AUC=2) and paclitaxel (100 mg/m2) for three out of four weeks. The third arm was carboplatin (AUC=2) and paclitaxel (150 mg/m2) weekly for six out of eight weeks.
On the first arm, median survival in patients 70 and older was 49 weeks compared to 48 weeks in patients younger than 70. On the second arm, median survival in older patients was 26 weeks compared to 33 weeks in younger patients; and, on the third arm, median survival in older patients was 63 weeks compared to 40 weeks in younger patients.
In addition to similar median survival rates, older patients appeared to tolerate the combination therapy at comparable rates to that of younger patients. On arm one, 14 percent of older patients experienced grade four neutropenia – a white blood cell reduction that places patients at greater risk for infections – compared to 5 percent of younger patients; on arm two, 3 percent of older patients compared to 1 percent of younger patients had the same experience; and on arm three, 12 percent of older patients compared to 10 percent of younger patients experienced grade four neutropenia.
A difficult cancer to treat due to its advanced stage at diagnosis, lung cancer will be newly-diagnosed in over 170,000 people in the United States in 2003. Incidence of lung cancer increases as people age and is highest in individuals over the age of 70.
Co-investigator of the study was Sakkaraiappan Ramalingam, M.D., University of Pittsburgh. Support for the study was provided by Bristol-Myers Squibb.