Carboplatin-Pemetrexed Effective for Elderly Patients With Non-small Cell Lung Cancer

By Reuters Staff

March 25, 2020

NEW YORK (Reuters Health) - Carboplatin plus pemetrexed followed by maintenance pemetrexed is an effective alternative to docetaxel monotherapy for elderly patients with advanced nonsquamous non-small-cell lung cancer (NSCLC), researchers in Japan report.

In an earlier study, Dr. Isamu Okamoto of the Graduate School of Medical Sciences, Kyushu University, in Fukuoka, and colleagues found that progression-free survival and response rates were better with docetaxel than with vinorelbine in elderly patients with advanced NSCLC.

Based on favorable results in a single-arm phase-2 study, they undertook a noninferiority phase-3 randomized clinical trial of treatment with carboplatin plus pemetrexed followed by pemetrexed maintenance therapy compared with docetaxel monotherapy in 433 cytotoxic chemotherapy-naive patients 75 years or older with advanced nonsquamous NSCLC.

With a median follow-up time of 17.1 months, overall survival in the carboplatin-pemetrexed group (74.5%) was noninferior to that in the docetaxel group (77.0%), the researchers report in JAMA Oncology.

The median overall survival was 18.7 months with carboplatin-pemetrexed and 15.5 months with docetaxel, and the two-year overall survival rates were 40.0% and 33.4%, respectively.

Overall response rates did not differ significantly between the carboplatin-pemetrexed (36.8%) and docetaxel (28.2%) groups.

Compared with docetaxel treatment, carboplatin-pemetrexed treatment was associated with fewer decreases in white blood cell count and neutrophil count and a lower incidence of febrile neutropenia, but with higher incidences of anemia and platelet count decreases.

Quality of life scores in both treatment groups improved from baseline to week 18.

"Carboplatin-pemetrexed treatment followed by pemetrexed maintenance is a valid option for first-line treatment of elderly patients with advanced non-squamous NSCLC," the researchers conclude.

The study had no commercial funding.

Dr. Okamoto did not respond to a request for comments.

SOURCE: JAMA Oncology, online March 12, 2020.


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