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Cisplatin plus etoposide in advanced non-small cell lung cancer patients age of 70 years or older
Lung Cancer (2003) 41, 233 /234
www.elsevier.com/locate/lungcan
LETTER TO THE EDITOR Cisplatin plus etoposide in advanced non-small cell lung cancer patients age of 70 years or older
Dear Sir, Cisplatin-based chemotherapy is now considered standard treatment for advanced or metastatic non-small cell lung cancer (NSCLC) [1 /3]. More than 30% of NSCLC patients are over the age of 70 [1,2]. Most likely due to fear of renal toxicity, elderly patients are not considered eligible for cisplatin-based chemotherapy in clinical practice. Thus, few clinical experiences with cisplatin-based chemotherapy in elderly NSCLC patients have been reported. We conducted a study to evaluate the feasibility and activity of the cisplatin plus etoposide combination in elderly patients (70 years old or more) with stage IIIB or IV NSCLC (Table 1). Chemotherapy-naive 24 patients with a performance status of 0 /2 were enrolled. There were 22 men and two women, with a median age of 72 (range 70 /77). Seven patients had stage IIIB and 17 had stage IV disease at the enrollment. More than half the patients with stage IV disease had two or more disease sites. Five patients had priory therapy Table 1 Patient characteristics (n /24) Median age (years) (range)
72 (70 /77)
Gender Male Female
22 2
ECOG performance status 0 1 2
/ 15 9
Histology Adenocarcinoma Squamous cell
5 19
Stage IIIB IV
7 17
Previous therapy None Radiotherapy
20 4
including brain irradiation for brain metastasis and chest radiotherapy for primary lesion. A normal bone marrow, kidney, liver and heart function was required for patients to enter the trial. Cisplatin was given intravenously (i.v.) at 60 mg/ m2 on day 1 and etoposide was given i.v. at 120 mg/ m2 on days 1 /3. Prior to cisplatin patients received i.v. hydration with 1 l fluids/KCl 20 mEq/MgSO4 8 mEq over 90 min. All patients received antiemetic prophylaxis that consisted of dexametazone 20 mg i.v. and i.v. 5-HT3 antagonists at standard dose. Cisplatin was diluted in 1000 ml normal saline and administered by 4-h infusion. After cisplatin administration, patients received furocemide 20 mg i.v./mannitol 25 gr i.v./1 l of fluids over 2 h. The cycle was repeated every 4 weeks. All patients underwent tumor response assessment after three cycles. An additional three cycles were administered in patients with either objective tumor response or stable disease, according to the World Health Organization (WHO) response criteria. A total of 116 cycles of cisplatin and etoposide were administered, with a median number of 4.5 cycles (range 2 /6). Twelve patients (50%) completed all six cycles of treatment. No death related to toxicity of treatment was recorded. No complete response was achieved; three patients (12.5%) obtained a partial response, with 12 (50%) stable disease and nine (37.5%) progressive disease. The median time to progression was 12 weeks, the median survival was 48.5 weeks and the 1-year survival rate was 38%. Four patients (16.6%) had WHO grade 3 /4 neutropenia, five (20.8%) had grade 3 anemia, one (4.1%) had grade 4 thrombocytopenia, and six (25%) had grade 3 neuropathy. Grade 2 vomiting was observed in four (16.6%) patients. One patient stopped treatment due to grade 3 nephrotoxicity, after fifth cycle of chemotherapy. In conclusion, cisplatin and etoposide combination is moderately active and well tolerated in elderly NSCLC patients, if it is given carefully. Advanced age alone should not preclude cisplatinbased chemotherapy.
0169-5002/03/$ - see front matter – 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00199-5
234
Letter to the Editor
References [1] Gridelli C. Chemotherapy of non-small cell lung cancer in elderly. Lung Cancer 2002;38:67 /70. [2] Gridelli C, Hainsworth J. Meeting the chemotherapy needs of elderly and poor performance status patients with NSCLC. Lung Cancer 2002;38:37 /41. [3] Inoue A, Kunitoh H, Mori K, et al. Phase I trial of weekly docetaxel in elderly patients with non-small cell lung cancer. Lung Cancer 2002;38:205 /9.
Ozkan Kanat, Turkkan Evrensel, Mutlu Demiray, Ender Kurt, Guzin Gonullu,
.
Murat Arslan, Osman Manavoglu Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa 16059, Turkey E-mail address: [email protected] Atılla Ozkan Department of Internal Medicine, Faculty of Medicine, Uludag University, Bursa 16059, Turkey
www.elsevier.com/locate/lungcan
LETTER TO THE EDITOR Cisplatin plus etoposide in advanced non-small cell lung cancer patients age of 70 years or older
Dear Sir, Cisplatin-based chemotherapy is now considered standard treatment for advanced or metastatic non-small cell lung cancer (NSCLC) [1 /3]. More than 30% of NSCLC patients are over the age of 70 [1,2]. Most likely due to fear of renal toxicity, elderly patients are not considered eligible for cisplatin-based chemotherapy in clinical practice. Thus, few clinical experiences with cisplatin-based chemotherapy in elderly NSCLC patients have been reported. We conducted a study to evaluate the feasibility and activity of the cisplatin plus etoposide combination in elderly patients (70 years old or more) with stage IIIB or IV NSCLC (Table 1). Chemotherapy-naive 24 patients with a performance status of 0 /2 were enrolled. There were 22 men and two women, with a median age of 72 (range 70 /77). Seven patients had stage IIIB and 17 had stage IV disease at the enrollment. More than half the patients with stage IV disease had two or more disease sites. Five patients had priory therapy Table 1 Patient characteristics (n /24) Median age (years) (range)
72 (70 /77)
Gender Male Female
22 2
ECOG performance status 0 1 2
/ 15 9
Histology Adenocarcinoma Squamous cell
5 19
Stage IIIB IV
7 17
Previous therapy None Radiotherapy
20 4
including brain irradiation for brain metastasis and chest radiotherapy for primary lesion. A normal bone marrow, kidney, liver and heart function was required for patients to enter the trial. Cisplatin was given intravenously (i.v.) at 60 mg/ m2 on day 1 and etoposide was given i.v. at 120 mg/ m2 on days 1 /3. Prior to cisplatin patients received i.v. hydration with 1 l fluids/KCl 20 mEq/MgSO4 8 mEq over 90 min. All patients received antiemetic prophylaxis that consisted of dexametazone 20 mg i.v. and i.v. 5-HT3 antagonists at standard dose. Cisplatin was diluted in 1000 ml normal saline and administered by 4-h infusion. After cisplatin administration, patients received furocemide 20 mg i.v./mannitol 25 gr i.v./1 l of fluids over 2 h. The cycle was repeated every 4 weeks. All patients underwent tumor response assessment after three cycles. An additional three cycles were administered in patients with either objective tumor response or stable disease, according to the World Health Organization (WHO) response criteria. A total of 116 cycles of cisplatin and etoposide were administered, with a median number of 4.5 cycles (range 2 /6). Twelve patients (50%) completed all six cycles of treatment. No death related to toxicity of treatment was recorded. No complete response was achieved; three patients (12.5%) obtained a partial response, with 12 (50%) stable disease and nine (37.5%) progressive disease. The median time to progression was 12 weeks, the median survival was 48.5 weeks and the 1-year survival rate was 38%. Four patients (16.6%) had WHO grade 3 /4 neutropenia, five (20.8%) had grade 3 anemia, one (4.1%) had grade 4 thrombocytopenia, and six (25%) had grade 3 neuropathy. Grade 2 vomiting was observed in four (16.6%) patients. One patient stopped treatment due to grade 3 nephrotoxicity, after fifth cycle of chemotherapy. In conclusion, cisplatin and etoposide combination is moderately active and well tolerated in elderly NSCLC patients, if it is given carefully. Advanced age alone should not preclude cisplatinbased chemotherapy.
0169-5002/03/$ - see front matter – 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00199-5
234
Letter to the Editor
References [1] Gridelli C. Chemotherapy of non-small cell lung cancer in elderly. Lung Cancer 2002;38:67 /70. [2] Gridelli C, Hainsworth J. Meeting the chemotherapy needs of elderly and poor performance status patients with NSCLC. Lung Cancer 2002;38:37 /41. [3] Inoue A, Kunitoh H, Mori K, et al. Phase I trial of weekly docetaxel in elderly patients with non-small cell lung cancer. Lung Cancer 2002;38:205 /9.
Ozkan Kanat, Turkkan Evrensel, Mutlu Demiray, Ender Kurt, Guzin Gonullu,
.
Murat Arslan, Osman Manavoglu Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa 16059, Turkey E-mail address: [email protected] Atılla Ozkan Department of Internal Medicine, Faculty of Medicine, Uludag University, Bursa 16059, Turkey