1357 - Very elderly inoperable NSCLC patients above 75 years compared to younger patients: equal activity of platinum-based doublet chemotherapy but higher...

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Complications of Treatment
Non-Small-Cell Lung Cancer, Metastatic
Cancer in Special Situations
Presenter Jan Nyrop Jakobsen
Authors J.N. Jakobsen, S. Wallerek, S.A. Jensen, J.B. Sorensen
  • Department Of Oncology, Rigshospitalet, Copenhagen University Hospital, 2100 - Copenhagen/DK

Abstract

Purpose

Tolerability and activity of platinum-based doublet chemotherapy was examined in very elderly inoperable NSCLC patients aged >75 years and compared to younger patients.

Patients and methods

Chemotherapy naïve inoperable NSCLC patients aged > 18 years with no upper age limit received Carboplatin AUC 5 and Vinorelbine (VNB) 25 mg/m2 day 1 and VNB 80 mg/m2 orally day 8 q 3 weeks for maximum 6 courses without g-csf. They were divided in group A being 70 years, group B 70-75 years, and group C > 75 years.

Results

A total of 135 patients received 530 treatment courses (group A 70 patients, group B 40 patients, and group C 25 patients). There were no differences in pre-treatment characteristics such as gender, histologic subtype, performance status, weight loss, or stage. The median age (with range), and frequencies of performance status 2, stage IV, and subsequent 2nd line chemotherapy were in group A 59.8 years (36-69), 23%, 69%, and 39%, in group B 72.3 years (70-75), 25%, 60%, and 23%, and in group C 78.0 years (76-84), 20%, 60%, and 12%, respectively. The frequencies of grade 4 and grade 3 and 4 leucopenia were 32% and 48% in group C and 6% and 23% in group A, respectively (p = 0.001, p = 0.018) and the frequency of febrile neutropenia in C (20%) and in A (7%) (p = 0.072). There were no toxic deaths. Response rates for groups A, B, and C were 33%, 34%, and 44% and median survivals (with range) were 35 weeks (1-336), 42 weeks (0-104+), and 58+ weeks (7-296), respectively (not significant). Median times to progression were 19, 29, and 16 weeks, respectively.

Conclusions

Very elderly patients aged > 75 years could receive similar number of treatment courses as younger patients and with similar level of toxicity except for leucopenia and febrile neutropenia, which were more frequent in the very elderly compared to the younger groups. The activity of Carboplatin and Vinorelbine was statistically similar between age groups, though with a remarkable trend towards higher disease control rate (NC + PR + CR) among the elderly and very elderly. Platinum-based doublet chemotherapy is feasible and highly active in very elderly NSCLC patients but require close hematologic monitoring. The use of bone marrow stimulating treatment may be considered to diminish toxicity in this population.

Disclosure

All authors have declared no conflicts of interest.