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Annals of Oncology 15:419-426, 2004
© 2004 European Society for Medical Oncology

Original Paper

Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel

Received 1 July 2003; revised 7 October 2003; accepted 27 October 2003

Background:

Platinum-based combination chemotherapy is currently recommended as the standard treatment for patients with advanced non-small-cell lung cancer (NSCLC), but its benefit seems limited to fit patients with a performance status (PS) of 0 or 1. For PS2 patients, there is no consensus on standard treatment. With the aims of reviewing the evidence supporting each of these therapeutic options, possibly reaching a consensus for treatment of PS2 patients affected by advanced NSCLC in clinical practice, and suggesting the priorities for clinical research in this field, an European Experts Panel took place in Avellino, Italy in April 2003.

Results and conclusions

On the basis of current evidence, chemotherapy treatment appears justified for patients with advanced NSCLC and PS2. Single-agent chemotherapy (gemcitabine, vinorelbine, taxanes) could be the preferred option, although carboplatin-based or low-dose cisplatin-based doublets may represent alternative options. Stronger evidence is expected from new clinical research specifically focused on PS2 patients. Single-agent chemotherapy should be the standard arm against which experimental treatments are tested in randomised trials dedicated to PS2 patients. High priority should be given to the evaluation of tolerability and efficacy of platinum-based combinations, and to the testing of new biological agents. Another research priority is the improvement of supportive care. Patients strongly need symptomatic improvement: end points such as symptom relief, clinical benefit and quality of life should have a central position in trials dedicated to PS2 NSCLC patients.

C. Gridelli1,*, A. Ardizzoni2, T. Le Chevalier3, C. Manegold4, F. Perrone5, N. Thatcher6, N. van Zandwijk7, M. Di Maio5, O. Martelli8 and F. De Marinis8

1 Division of Medical Oncology, ‘S.G.Moscati’ Hospital, Avellino; 2 Department of Medical Oncology, National Institute for Cancer Research, Genoa, Italy; 3 Department of Medicine, Institute Gustave Roussy, Villejuif, France; 4 Department of Medical Oncology, Thoraxklinik, Heidelberg, Germany; 5 Clinical Trials Unit, National Cancer Institute, Naples, Italy; 6 Department of Medical Oncology, Christie Hospital, Manchester, UK; 7 Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; 8 Fifth Pulmonary-Oncology Unit, Lung Disease Department, Forlanini Hospital, Rome, Italy

Key words: advanced disease, chemotherapy, consensus, non-small-cell lung cancer, performance status 2


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