Annals of Oncology 12:957-962, 2001
© 2001 European Society for Medical Oncology
research-article |
Etoposide phosphate with carboplatin in the treatment of elderly patients with small-cell lung cancer: A phase II study
1Pulmonology Unit, University Hospital Strasbourg
2Pulmonology Unit, University Hospital Belfort
3Pulmonology Unit, University Hospital Brest
4Pulmonology Unit, University Hospital Besancon
5Pulmonology Unit, University Hospital Vesoul
6Pulmonology Unit, University Hospital Metz
7Pulmonology Unit, University Hospital Stesbourg
8Pulmonology Unit, University Hospital Saint-Brieuc
9Pulmonology Unit, University Hospital Tours
10Pulmonology Unit, University Hospital Paris, France
Correspondence to E. Quoix, MD Pulmonology unit University Hospital I place de 1'hopital 67091 Strasbourg Cedex France E-mail: Elisabeth.Quoix{at}chru-strasbourg.fr
Background: Although the average age of lung cancer patients is increasing, many elderly patients remain undertreated, mainly because of the fear of higher treatment toxicity in this category of patients. We conducted a study to evaluate the efficacy and tolerability of a combination therapy with carbo platin (C) and etoposide phosphate (EP) in elderly patients with Small-Cell Lung Cancer (SCLC).
Patients and methods. Previously untreated patients older than 70 years with stage IIIB/IV SCLC received a combination of EP (100 mg/m2 D1, D2, D3) and C (Dl, dose calculated according to the Calvert formula). Response rate, survival and toxicity were assessed.
Results: Thirty-eight patients (mean age 76 years, range 70–88 years) received a total of 162 cycles. Eighteen patients (47%) received the six scheduled cycles. Thirty patients were evaluable for efficacy (2 CR and 20 PR). The median survival was 237 days and the one-year probability of survival was 26%. The most common adverse effect was transient grade 3 or 4 neutropenia, observed during 57% of evaluable cycles, while five episodes of febrile neutropenia also occurred, with one fatal (bactaeriernia). It is noteworthy that no renal or liver toxicity was observed, and no mucitis was noted. Unfortu nately, a relatively high proportion of patients died shortly after the start of the study. Although most deaths seemed unrelated to the treatment, the possibility of its exacerbatory effect on comorbidities, especially cardiovascular, cannot be excluded.
Conclusion: The two-drug regimen of carboplatin and etoposide phosphate is feasible in most elderly patients with an acceptable toxicity, and the overall results suggest that patients even older than 70 years may benefit from full treatment. Therefore, consideration should be given to offering active treatment to most patients with SCLC, regardless of age but with special attention paid to cornorbidities.
carboplatin, chemotherapy, comorbidity, elderly, etoposide phosphate, small-cell lung cancer
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