Cisplatin-Based Therapy for the Treatment of Elderly Patients with Non-Small-Cell Lung Cancer: a Retrospective Analysis of a Single Institution

Abstract

Background: In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. Methods: Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 mg/m 2 on days 1, 8 and cisplatin was added at 75 mg/m 2 on day 1. In the second group (DC), 75 mg/m 2 docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. Result: GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). Conclusion: The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatmetns with regard to sensory neuropathy.

First and Second Line Chemotherapeutic Regimens for Non-Small Cell Lung Carcinomas - The Efficacy of Platinum, Non-Platinum and Combination Therapy: A Literature Review

“…The articles analyzed the efficacy of platinum, non-platinum or combination therapeutic regimens while also advocating towards specific treatment modalities. Nine studies advocate for combination therapy as an effective treatment regimen for first-line NSCLC [7][8][9][10][11][12][13][14][15], five studies advocate towards non-platinum based therapy as an effective and safer regimen [8,[16][17][18][19], one study concludes that non-platinum based therapy is an effective regimen compared to combination therapy in first-line NSCLC [20], two studies conclude that both non-platinum based regimens and combination therapy show an equal efficacy [21,22], three therapies indicate similar efficacy between platinum-based and non-platinum based regimens [23][24][25], two therapies indicate that the efficacy of non-platinum based therapy is similar to the efficacy of other treatment regimens [26,27], one study states that platinum-based regimens showed a higher efficacy and response rate than non-platinum based regimens [28], 12 studies advocate for non-platinum based regimens as a second line treatment regimen [29][30][31][32][33][34][35][36][37][38][39][40], and two studies advocate towards combination therapy for second-line treatment [41,42]. Most of the articles lean towards the use of combination therapy for first-line treatment and non-platinum based therapy for second-line treatment.…”

Incidence of Hematologic Toxicity in Older Adults Treated with Gemcitabine or a Gemcitabine-Containing Regimen in Routine Clinical Practice: A Multicenter Retrospective Cohort Study

“…Although multiple, older adult-specific clinical trials with gemcitabine have reported a manageable hematologic toxicity profile [23][24][25][26], clinical trials in older adults receiving platinum-doublet remain scarce and difficult to extrapolate because of divergent treatment regimens and geriatric patient populations [2,[27][28][29]. Comparative analyses of hematologic toxicity in clinical trials including both geriatric and nongeriatric patients showed conflicting results [8,30].…”

A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial

“…Patients in the control group will receive mainline treatments of platinum-based doublet chemotherapy (GP, TP, or DP). The three regimens have no statistically significant difference in the response rates, PFS, and OS [ 16 ]. A chemotherapy cycle is 21 or 28 days in length.…”

“…Currently, large-scale clinical trials always exclude elderly patients with lung cancer [ 15 ]. As a result, there is little high-level or large-scale evidence from evidence-based medicine with a focus on the elderly with lung cancer [ 16 ]. Therefore, there is an urgent need to find a new effective therapy with less toxicity for the elderly with lung cancer.…”