Prognostic Factors In Elderly Patients With Advanced Non-Small Cell Lung Cancer Treated With Platinum-Based Doublet Chemotherapy.

JOURNAL OF CLINICAL ONCOLOGY(2011)

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Abstract
e19584 Background: To identify prognostic factors in elderly patients with advanced non-small cell lung cancer treated with platinum based doublet chemotherapy. Methods: Between January 2005 and December 2009, 191 patients aged over 70 years with advanced non-small cell lung cancer who were treated with platinum based doublet chemotherapy were analyzed retrospectively. Results: The median age was 72 years (range, 70 – 81 years) and 162 patients (84.8%) were aged 70 to 75. A total of 177 patients (92.7%) were stage IV, and 111 patients (58.1%) were adenocarcinoma. Seventy-nine patients (41.4%) received cisplatin based chemotherapy and 112 patients (58.6%) received carboplatin based chemotherapy. In both groups, gemcitabine was commonly used in combination with platinum (gemcitabine/cisplatin 69 of 79, gemcitabine/carboplatin 108 of 112). The median number of treatment cycles was 4 cycle (range, 1~6). The overall response rate was 40.3% (intent to treat) and overall survival was 10 months (95% C.I. 8.3-11.7). The main grade 3/4 toxicities were neutropenia (33.1%) and thrombocytopenia (17.1%). treatment-related death was 6.3% (12 of 191). Univariate analysis demonstrated that smoking history (never vs ever), body mass index, underlying lung parenchymal disease, history of cerebrovascular accidents (CVA), bone or liver metastasis at diagnosis, subtype (adenocarcinoma versus non-adenocarcinoma), EGFR mutation, hemoglobin (<12 g/dL), serum albumin (<3.5 mg/dL) were significantly associated with overall survival. On multivariate analysis, poor prognostic factors for overall survival were hemoglobin <12 g/dL (hazards ratio [HR] of 1.75; 95% confidence interval [CI], 1.17-2.61 [P =.006]), history of CVA (HR of 2.20; 95% CI, 1.13-4.30 [P =.021]), ever-smoking (HR of 1.73; 95% CI, 1.16-2.58 [P =.007]), liver metastasis at diagnosis (HR of 2.46; 95% CI, 1.25-4.83 [P =.009]), and bone metastasis at diagnosis (HR of 1.64; 95% CI, 1.13-2.39 [P =.009]). Conclusions: Platinum based doublet chemotherapy might be effective and tolerable in fit, elderly patients with advanced non-small cell lung cancer. However, Platinum doublet chemotherapy should be considered for selected patients.
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Key words
doublet chemotherapy,lung cancer,elderly patients,non-small,platinum-based
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