Elderly Lung Cancer Patients Benefit More From Combination Chemotherapy Than Monotherapy

Editor's Choice
Academic Journal
Main Category: Lung Cancer
Also Included In: Cancer / Oncology;  Respiratory / Asthma
Article Date: 09 Aug 2011 - 19:00 PDT


Giving elderly lung cancer patients platinum-based doublet chemotherapy lengthens median overall survival considerably compared to monotherapy, despite its increased toxic effects - treatment for those on monotherapy should be revised, French researchers wrote in The Lancet.

Cancer kills more men globally than any other cancer, while among females in America it has been the leading cause of death from cancer since 1987. As people are living longer and cancer risk rises with age, there has been a considerable rise in lung cancer rates among elderly individuals. The median age at which lung cancer is diagnosed today in industrialized nations is between 63 and 70 years.

Many elderly patients may not be receiving the best treatment because doctors, patients and their families wonder about the toxic effects some medications have.

Current guidelines recommend monotherapy for patients with advance NSCLC (non-small cell lung cancer) aged over 70 years and platinum-based doublet chemotherapy for fit younger individuals.

Professor Elisabeth Quoix, Department of Chest Diseases, Hopitaux Universitaires de Strasbourg and Université de Strasbourg, France, and team compared carboplatin and paclitaxel doublet chemotherapy with monotherapy in elderly individuals with advanced NSCLC.

451 participants were enrolled in this Phase III randomized trial. 226 of them received monotherapy while the other 225 were administered doublet chemotherapy (combination therapy). The median follow-up was 30 months, and the average age of the patients was 77 years.

The researchers found that:

• Median overall survival in the doublet chemotherapy group was 10.3 months
• Median overall survival in the monotherapy group was 6.2 months
• 1 year survival in the doublet group was 45%
• 1 year survival in the monotherapy group was 25%
• 48% of those in the doublet therapy group had depleted white blood cell count
• 12% of those in the monotherapy group had depleted white blood cell count
• Feelings of weakness affected 10% of those in the doublet group
• 6% of those in the monotherapy group had feelings of weakness

Even though the authors recognize that prior trials that focused on elderly individuals with advanced NSCLC concluded that monotherapy was the best treatment, they concluded:

"Most post-hoc subgroup analyses of elderly patients enrolled in clinical trials with no upper limit of age, however, suggested that fit elderly patients might gain similar benefits to their younger counterparts from platinum-based doublet chemotherapy. Our study of carboplatin and paclitaxel doublet chemotherapy versus gemcitabine or vinorelbine monotherapy showed a survival benefit with the doublet chemotherapy. We believe that treatment current paradigm for elderly patients with advanced non-small-cell lung cancer should be reconsidered."

Linked Comment in the same journal

Dr Karen L Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA, USA, stated:

"Older patients dominate the lung cancer population, but continue to be under-represented in clinical trials. Additional studies are needed that enrol adequate numbers of older adults, and include a comprehensive geriatric assessment to provide the knowledge required to properly assess the risk-benefit ratio in treatment decisions, so that a personalised approach can be taken."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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