Superiority of Carboplatin-Based Doublets to Cisplatin-Based Doublets among Medicare Patients Aged 70 and Older with Advanced Lung Cancer

Abstract

IntroductionLung cancer is the second most common cancer in both men and women in the United States (US), the leading cause of cancer death for men and women, and arguably a disease of the elderly [1]. Of the >224,000 American men and women who were diagnosed with lung cancer in 2014, greater than 70% were diagnosed at or after age 65.1 Among these 155,000 elderly individuals, more than half were diagnosed with disseminated (i.e., metastatic) disease, which is incurable and often rapidly fatal (i.e., median survival <12 months) even with aggressive chemotherapy treatments.Over the last thirty years, randomized clinical trials (RCTs) have established that treatment with chemotherapy both improves quality of life and extends survival over best supportive care alone in patients with advanced non-small cell lung cancer (NSCLC), which is the most common form of lung cancer in the US [2]. Subsequent research has established that combination chemotherapy with "platinum-based" doublet chemotherapy regimens is superior to single agents or non-platinum-based combination regimens [3][4][5]. Among platinum-based doublets regimens, there is ambiguity in clinical oncology about which platinum-containing drug (i.e., cisplatin or carboplatin) confers the greatest benefit. Some randomized trials reported no Background: Some evidence suggests that cisplatin-based chemotherapy doublet regimens are more effective than the less toxic carboplatin-based doublet regimens for patients with advanced non-small cell lung cancer (NSCLC), but their effectiveness among elderly cancer patients who are treated in usual care settings is not known.