Elderly Patients with Advanced Non-Small Cell Lung Cancer

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Abstract

Objectives: The incidence of non-small cell lung cancer (NSCLC) is increasing among the elderly. We studied the toxicity and efficacy of a weekly schedule of gemcitabine and cisplatin in elderly patients with advanced NSCLC. Methods: Patients aged 70 years or above with advanced NSCLC were treated in a phase II prospective trial with gemcitabine 1,000 mg/m<sup>2</sup> and cisplatin 35 mg/m<sup>2</sup> on days 1, 8 and 15 every 28 days. Results: Forty-eight patients with a median age of 74 years (range 70–78) participated in the study. We observed 14 cases with partial response, 14 with stable disease and 16 with progressive disease, whilst 4 patients were not evaluable. By intention-to-treat analysis, partial response rate was 31.8% whilst progressive disease was 33.3%. Median survival was 9 months; 1-year survival probability was 34.4% and median time to progression was 4 months. Grade III–IV leukopenia was observed in 5/48 patients (10.4%), 20/48 patients (41.7%) had grade III–IV thrombocytopenia and 7/48 patients (14.6%) had grade III–IV anemia. One patient experienced grade III emesis and 2 patients had grade III–IV fatigue. Conclusions: At this dose and schedule the combination of gemcitabine and cisplatin appears to be an active and well-tolerated regimen for elderly patients with advanced NSCLC.

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Gemcitabine plus best supportive care (BSC) vs BSC in inoperable non-small cell lung cancer – a randomized trial with quality of life as the primary outcome

G Anderson, P Hopwood, Sebastién R J Stephens … (2000)

Three hundred patients with symptomatic, locally advanced or metastatic NSCLC not requiring immediate radiotherapy were enrolled into this randomized multicentre trial comparing gemcitabine + BSC vs BSC alone. Patients allocated gemcitabine received 1000 mg/m2on days 1, 8 and 15 of a 28-day cycle, for a maximum of six cycles. The main aim of this trial was to compare patient assessment of a predefined subset of commonly reported symptoms (SS14) from the EORTC QLQ-C30 and LC13 scales. The primary end-points were defined as (1) the percentage change in mean SS14 score between baseline and 2 months and (2) the proportion of patients with a marked (≥ 25%) improvement in SS14 score between baseline and 2 months sustained for ≥4 weeks. The secondary objectives were to compare treatments with respect to overall survival, and multidimensional QL parameters.The treatment groups were balanced with regard to age, gender, Karnofsky performance status (KPS) and disease stage (40% had metastatic disease). The percentage change in mean SS14 score from baseline to 2 months was a 10% decrease (i.e. improvement) for gemcitabine plus BSC and a 1% increase (i.e. deterioration) for BSC alone (P = 0.113, two-sample t -test). A sustained (≥ 4 weeks) improvement (≥25%) on SS14 was recorded in a significantly higher proportion of gemcitabine + BSC patients (22%) than in BSC alone patients (9%) (P = 0.0014, Pearson’s chi-squared test). The QLQ-C30 and L13 subscales showed greater improvement in the gemcitabine plus BSC arm (in 11 domains) than in the BSC arm (one symptom item). There was greater deterioration in the BSC alone arm (six domains/items) than in the gemcitabine + BSC arm (three QL domains). Tumour response occurred in 19% (95% CI 13–27) of gemcitabine patients. There was no difference in overall survival: median 5.7 months (95% CI 4.6–7.6) for gemcitabine + BSC patients and 5.9 months (95% CI 5.0–7.9) (log-rank, P = 0.84) for BSC patients, and 1-year survival was 25% for gemcitabine + BSC and 22% for BSC. Overall, 74 (49%) gemcitabine + BSC patients and 119 (79%) BSC patients received palliative radiotherapy. The median time to radiotherapy was 29 weeks for gemcitabine + BSC patients and 3.8 weeks for BSC. Patients treated with gemcitabine + BSC reported better QL and reduced disease-related symptoms compared with those receiving BSC alone. These improvements in patient-assessed QL were significant in magnitude and were sustained. © 2000 Cancer Research Campaign

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The National Cancer Data Base report on lung cancer.

David Fry, H R Menck, Paul D Winchester (1996)

Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1992) data for lung cancer are described here. Four Calls for Data have yielded a total of 560,455 lung cancer cases diagnosed in 1986-1987 and 599,597 cancer cases diagnosed in 1992, from hospital cancer registries across the United States. A total of 91,115 lung cancer cases diagnosed in 1986-1987 and 92,182 diagnosed in 1992 were reported from cancer registries across the United States. Lung cancer occurs mainly in patients between the ages of 50 and 80 years. There was an increasing relative frequency of adenocarcinoma, and of lung cancer in women, and a noteworthy poor prognosis among African Americans. Lung cancer patients were reported from all types and sizes of hospitals in America, from smaller community hospitals to major teaching centers. Treatment by surgical resection occurred more frequently in the major cancer centers. The overall prognosis for lung cancer remains extremely poor. For a selective category of patients (Stage I), cancer-directed surgery offers reasonable cure rates, but these data underline the need for earlier diagnosis and improved treatment modalities in the overall management of lung cancer patients.

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Polychemotherapy in advanced non small cell lung cancer: a meta-analysis

R. Cellerino, Y Cormier, P.A. Ganz … (1993)

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Author and article information

Journal

Journal ID (publisher-id): OCL

Journal ID (nlm-ta): Oncology

Journal ID (doi): 10.1159/issn.0030-2414

Title: Oncology

Publisher: S. Karger AG

ISSN (Print): 0030-2414

ISSN (Electronic): 1423-0232

Publication date Subscription-year: 2003

Publication date (Print): December 2003

Publication date (Electronic): 05 December 2003

Volume: 65

Issue: 3

Pages: 198-203

Affiliations

^aMedical Oncology Unit and ^bEpidemiology and Biostatistics, University of Ancona, Ancona, ^cMedical Oncology Unit, Fabriano, and ^dMedical Oncology Unit, Senigallia, Italy

Article

Publisher ID: 74471 Other ID: Oncology 2003;65:198–203

DOI: 10.1159/000074471

PubMed ID: 14657592

SO-VID: 78378f67-df23-4b92-9eb1-9158bb05edd8

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 12 February 2003

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Tables: 2, References: 31, Pages: 6

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Elderly Patients with Advanced Non-Small Cell Lung Cancer

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Abstract

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Karger: Oncology

Most cited references 10

Gemcitabine plus best supportive care (BSC) vs BSC in inoperable non-small cell lung cancer – a randomized trial with quality of life as the primary outcome

The National Cancer Data Base report on lung cancer.

Polychemotherapy in advanced non small cell lung cancer: a meta-analysis

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Cited by 4

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