CISPLATIN-BASED COMBINATION CHEMOTHERAPY FOR ELDERLY PATIENTS WITH NON-SMALL-CELL LUNG-CANCER

Purpose: To compare the response rates, toxicities and survival durati ons of elderly patients (70 years of age or more) with those of younge r patients ( less than 70 years of age) with non-small-cell lung cance r (NSCLC) treated with cisplatin-based chemotherapy. Patients and meth ods: We analyzed retrospectively the data of 203 assessable patients e ntered on a prospective randomized trial of cisplatin-based combinatio n chemotherapy. Chemotherapy consisted of three dosage regimens: (1) v indesine and cisplatin (VP); (2) mitomycin, vindesine and cisplatin (M VP); or (3) etoposide and cisplatin alternating with vindesine and mit omycin (EP/??? VM). Results: A greater proportion of elderly patients had localized disease and more squamous cell carcinoma than non-elderl y patients. The overall response rates were 44% in the elderly group a nd 28% in the nonelderly group. In the EP/VM arm, the response rate wa s significantly better in the elderly group than in the nonelderly gro up. The frequency of grade 4 leukocytopenia in the MVP and EP/VM arms in the elderly group was significantly greater than in the non-elderly group (P < 0.05). No differences were found in nonhematological toxic ities between the two groups. There was no difference in overall survi val between the groups. Conclusion: Elderly patients treated with mito mycin-containing regimens have higher hematologic toxicities than youn ger patients. The results of this study are consistent with the previo usly reported pharmacologic data on mitomycin suggesting altered pharm acokinetics in elderly patients. The improved response rate in the eld erly patients was probably because more elderly patients had earlier d isease, squamous cell carcinoma and better performance status, Cisplat in-based chemotherapy was tolerable for most elderly NSCLC patients wi th good performance status.