Adjuvant Chemotherapy in Elderly Patients with Non-Small-Cell Lung Cancer

Cesare Gridelli, MD, Paolo Maione, MD, Daniela Comunale, MD, and Antonio Rossi, MD

Disclosures

Cancer Control. 2007;14(1):57-62. 

In This Article

Chemotherapy in Elderly Patients With NSCLC

The main clinical data on chemotherapy for elderly patients with NSCLC come from advanced disease. These data are useful for administering chemotherapy and for designing clinical trials in their early stages. The Elderly Lung Cancer Vinorelbine Italian Study (ELVIS), a phase III multicenter trial including 191 patients with advanced NSCLC, showed that single-agent vinorelbine improved quality of life and survival compared with supportive care alone (median survival,27 vs 21 weeks, P=.04).[19] Therefore, in elderly patients with advanced NSCLC, palliative chemotherapy should be considered. To improve these results with single-agent chemotherapy, some non–platin-based combinations have been developed. The most studied regimen is gemcitabine plus vinorelbine. The Multicenter Italian Lung Cancer in the Elderly Study (MILES), a large randomized phase III trial including 707 elderly patients, showed that the combination of vinorelbine plus gemcitabine is not more effective than single-agent vinorelbine or gemcitabine in the treatment of elderly patients with advanced NSCLC (Table 2).[20] Based on this background, and until results are available from prospective randomized trials of platin-based chemotherapy, singleagent chemotherapy should be considered a reasonable treatment choice in unselected elderly patients with advanced NSCLC.

Few prospective clinical experiences with cisplatin- based chemotherapy in elderly patients with NSCLC have been reported. Those that have been published show that cisplatin is particularly difficult to use in elderly patients because of renal and neurological side effects and potential hydration-related problems. The issue of cisplatin- or carboplatin-based therapy for elderly patients with advanced NSCLC has recently been addressed in some retrospective analyses of large randomized trials.[21,22,23,24,25,26] Treatment outcomes of patients younger and older than 70 years of age enrolled on these trials were compared. Globally, these analyses found no differences in survival between elderly and younger patients, with a small increase in toxicity in the elderly, and suggest that advanced age alone should not preclude platin-based chemotherapy for NSCLC.

The aforementioned analyses could suffer from selection bias. In fact, elderly patients enrolled in this sort of trial could be representative not of the whole elderly population but rather of a small subgroup believed by investigators to be eligible for aggressive treatments.[27]

Prospective clinical trials of platin-based chemotherapy with inclusion criteria limited to the elderly population are needed. A topic of interest is exploration of innovative schedules and attenuated doses of cisplatin that could be more suitable in the elderly. Good tolerability and activity has been reported by Feliu et al[28] with low-dose cisplatin (50 mg/m2) plus gemcitabine and by Maestu et al[29] with low-dose carboplatin (AUC 5) plus gemcitabine.

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