Advertisement

Comparison of two different carboplatin and weekly paclitaxel schedule in elderly advanced non-small cell lung cancer patients

  • Derya Kıvrak Salim
  • Tuğba Akın Telli
  • Ali Murat Tatlı
  • Sadettin Kılıçkap
  • Perran Fulden YumukEmail author
Original Article
  • 24 Downloads

Abstract

Purpose

In this study our aim was to compare efficacy and toxicity profiles of two different schedule of carboplatin-paclitaxel regimen in elderly advanced non-small cell lung cancer (NSCLC) patients.

Methods

Data from the charts of 59 elderly patients with metastatic NSCLC, treated with weekly paclitaxel combined with two different schedule of carboplatin were collected retrospectively from three medical oncology centers in Turkey between September 2002 to March 2018. No prior systemic therapy or radiotherapy was allowed. Brain metastases were not considered as exclusion criteria unless symptomatic. Patients were analyzed in two treatment groups; CP3 (who received 3 weekly carboplatin and weekly paclitaxel), and CP1 (weekly carboplatin and weekly paclitaxel). Overall survival (OS) was the primary endpoint of the study. Secondary end points were as follows: progression free survival (PFS), response rates (RR), grade 3–4 toxicities, skipped cycles, dose reductions, and treatment discontinuation rates.

Results

Twenty-four patients received 3 weekly carboplatin and weekly paclitaxel schedule (CP3) while weekly carboplatin and weekly paclitaxel schedule (CP1) was performed in 35 patients. CP3 had a median OS of 14 months whereas CP1 had 9 months of median OS (p = 0.084). Both treatments (CP3 vs CP1) had similar median PFS (7 months vs 4 months, p = 0.109) and objective RR (20.9% vs 29.4%, p = 0.465). There was an increased incidence of grade 3–4 anemia and grade 3–4 neutropenia in CP3 compared to CP1 (p = 0.003 in both), but no major differences in febrile neutropenia and infection toxicity profiles (p = 0.289 and p = 0.770, respectively). Weekly schedule (CP1) had a tendency of increased grade 3–4 neurotoxicity (33.3% vs 42.9%, p = 0.461).

Conclusion

Weekly carboplatin and paclitaxel might be more tolerable and is as effective as 3 weekly carboplatin and weekly paclitaxel schedule in metastatic elderly NSCLC patients.

Keywords

NSCLC Elderly Carboplatin Paclitaxel 

Abbreviations

AUC

Area under curve

CI

Confidence interval

CP3

3 weekly carboplatin with weekly paclitaxel

CP1

Weekly carboplatin with weekly paclitaxel

CT

Computed tomography

CTCAE

Common Terminology Criteria for Adverse Events

ECOG PS

Eastern Cooperative Oncology Group Performance Status

NSCLC

Non-small cell lung cancer

FEN

Febrile neutropenia

mo

Month

NA

Not available

NS

Not significant

NOS

Not otherwise specified

ORR

Objective response rate

OS

Overall survival

PD-L1

Programmed death ligand 1

PFS

Progression free survival

wk

Week

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

References

  1. 1.
    Howlander N, Noone AM, Krapcho M et al (2014) SEER cancer statistics review 1975-2012. National Cancer Institute, BethesdaGoogle Scholar
  2. 2.
    Yurdakul AS, Kocatürk C, Bayiz H, Gürsoy S, Bircan A, Özcan A, Akkoçlu A, Uluorman F, Çelik P, Köksal D, Ulubaş B, Sercan E, Özbudak Ö, Göksel T, Önalan T, Yamansavci E, Türk F, Yuncu G, Çopuraslan Ç, Mardal T, Tuncay E, Karamustafaoğlu A, Yildiz P, Seçik F, Kaplan M, Çağlar E, Ortaköylü M, Önal M, Turna A, Hekimoğlu E, Dalar L, Altin S, Gülhan M, Akpinar E, Savas İ, Firat N, Çamsari G, Özkan G, Çetinkaya E, Kamiloğlu E, Çelik B, Havlucu Y (2015) Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey. Cancer Epidemiol 39:216–221CrossRefGoogle Scholar
  3. 3.
    Chan BA, Hughes BG (2015) Targeted therapy for non-small cell lung cancer: current standards and the promise of the future. Transl Lung Cancer Res. 4:36–54Google Scholar
  4. 4.
    Gridelli C (2001) The ELVIS trial: a phase III study of single agent vinorelbine as first-line treatment in elderly patients with advanced non-small cell lung cancer. Elderly Lung Cancer Vinorelbine Italian study. Oncologist 6:4–7CrossRefGoogle Scholar
  5. 5.
    Des Guetz G, Uzzan B, Nicolas P, Valevre D, Sebbane G, Morere JF (2012) Comparison of the efficacy and safety of single agent and doublet chemotherapy in advanced non-small cell lung cancer in the elderly: a meta-analysis. Crit Rev Oncol Hematol 84:340–349CrossRefGoogle Scholar
  6. 6.
    Frasci G, Lorusso V, Panza N, Comella P, Nicolella G, Bianco A, De Cataldis G, Iannelli A, Bilancia D, Belli M, Massidda B, Piantedosi F, Comella G, De Lena M (2000) Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 18(13):2529–2536CrossRefGoogle Scholar
  7. 7.
    Quoix E, Zalcman G, Oster JP, Westeel V, Pichon E, Lavolé A, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Dansin E, Poudenx M, Molinier O, Vaylet F, Moro-Sibilot D, Herman D, Bennouna J, Tredaniel J, Ducoloné A, Lebitasy MP, Baudrin L, Laporte S, Milleron B, Intergroupe Francophone de Cancérologie Thoracique (2011) Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet 378(9796):1079–1088.  https://doi.org/10.1016/s0140-6736(11)60780-0 CrossRefGoogle Scholar
  8. 8.
    Georgoulias V, Papadakis E, Alexopoulos A, Tsiafaki X, Rapti A, Veslemes M, Palamidas P, Vlachonikolis I, Greek Oncology Cooperative Group (GOCG) for Lung Cancer (2001) Platinum-based and non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a randomised multicentre trial. Lancet 357(9267):1478–1484CrossRefGoogle Scholar
  9. 9.
    Gridelli C, Gallo C, Shepherd FA, Illiano A, Piantedosi F, Robbiati SF, Manzione L, Barbera S, Frontini L, Veltri E, Findlay B, Cigolari S, Myers R, Ianniello GP, Gebbia V, Gasparini G, Fava S, Hirsh V, Bezjak A, Seymour L, Perrone F (2003) Gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non-small-cell lung cancer: a phase III trial of the Italian GEMVIN Investigators and the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 21(16):3025–3034CrossRefGoogle Scholar
  10. 10.
    Launay-Vacher V, Chatelut E, Licchtman SM, Wildiers H, Steer C, Aapro M, International Society of Geriatric Oncology (2007) Reanal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol 18:1314–1321CrossRefGoogle Scholar
  11. 11.
    Battisti NML, Sehovic M, Extermann M (2017) Assessment of the external validity of the national comprehensive cancer network and european society for medical oncology guidelines for non–small-cell lung cancer in a population of patients aged 80 years and older. Clin Lung Cancer. 18:460–471CrossRefGoogle Scholar
  12. 12.
    Ramalingam S, Perry MC, La Rocca RV, Rinaldi D, Gable PS, Tester WJ, Belani CP (2008) Comparison of outcomes for elderly patients treated with weekly paclitaxel in combination with carboplatin versus the standard 3-weekly paclitaxel and carboplatin for advanced nonsmall cell lung cancer. Cancer 113(3):542–546CrossRefGoogle Scholar
  13. 13.
    Ramalingam S, Barstis J, Perry MC, La-Rocca RV, Nattam SR, Rinaldi D, Clark R, Mills GM, Belani CP (2006) Treatment of elderly non- small cell lung cancer patients with three different schedules of weekly paclitaxel in combination with carboplatin: subanalysis of a randomizedtrial. J Thorac Oncol 1:240–244CrossRefGoogle Scholar
  14. 14.
    Belani CP, Barstis J, Perry MC, La Rocca RV, Nattam SR, Rinaldi D, Clark R, Mills GM (2003) Multicenter, randomized trial for stage IIIB or IV non-small-cell lung cancer using weekly paclitaxel and carboplatin followed by maintenance weekly paclitaxel or observation. J Clin Oncol 21(15):2933–2939CrossRefGoogle Scholar
  15. 15.
    Schuette W, Blankenburg T, Guschall W, Dittrich I, Schroeder M, Schweisfurth H, Chemaissani A, Schumann C, Dickgreber N, Appel T, Ukena D (2006) Multicenter randomized trial for stage IIIB/IV non-small-cell lung cancer using every-3 week versus weekly paclitaxel/carboplatin. Clin Lung Cancer 7:338–343CrossRefGoogle Scholar
  16. 16.
    Savarese-Diane MF. Common terminology criteria for adverse events, versions 2-5. National Institute of Health-National Cancer Institute, Washington, DC. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm. Accessed 8 Apr 2019
  17. 17.
    Ricci S, Antonuzzo A, Galli L, Tibaldi C, Bertuccelli M, Lopes Pegna A, Petruzzelli S, Algeri R, Bonifazi V, Fioretto ML, Orlandini C, Conte PF (2000) Gemcitabine monotherapy in elderly patients with advanced non-small cell lung cancer: a multicenter phase II study. Lung Cancer. 27:75–80CrossRefGoogle Scholar
  18. 18.
    Kudoh S, Takeda K, Nakagawa K, Takada M, Katakami N, Matsui K, Shinkai T, Sawa T, Goto I, Semba H, Seto T, Ando M, Satoh T, Yoshimura N, Negoro S, Fukuoka M (2006) Phase III study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the West Japan Thoracic Oncology Group Trial (WJTOG 9904). J Clin Oncol 24:3657–3663CrossRefGoogle Scholar
  19. 19.
    Bakirhan K, Sharma J, Perez-Soler R, Cheng H (2016) Medical treatment in elderly patients with non-small cell lung cancer. Curr Treat Options Oncol 17(3):13CrossRefGoogle Scholar
  20. 20.
    Gajra A, Akbar SA, Din NU (2016) Management of lung cancer in the elderly. Clin Geriatr Med 32:81–95CrossRefGoogle Scholar
  21. 21.
    Fidias P, Supko JG, Martins R, Boral A, Carey R, Grossbard M, Shapiro G, Ostler P, Lucca J, Johnson BE, Skarin A, Lynch TJ (2001) A phase II study of weekly paclitaxel in elderly patients with advanced non-small cell lung cancer. Clin Cancer Res 7:3942–3949Google Scholar
  22. 22.
    Volk V, Calthomas R, Mark M, von Moos R, Klingbiel D, Brossart P, Mey U (2016) Weekly carboplatin in combination with weekly paclitaxel in the treatment of metastatic non-small cell lung cancer: a single center 10-year experience. Support Care Cancer 24:2119–2128CrossRefGoogle Scholar
  23. 23.
    Tabchi S, Kassouf E, Florescu M, Tehfe M, Blais N (2017) Factors influencing treatment selection and survival in advanced lung cancer. Curr Oncol. 24:e115–e122CrossRefGoogle Scholar
  24. 24.
    Lilenbaum RC, Herndon JE 2nd, List MA, Desch C, Watson DM, Miller AA, Graziano SL, Perry MC, Saville W, Chahinian P, Weeks JC, Holland JC, Green MR (2005) Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol 23:190–196CrossRefGoogle Scholar
  25. 25.
    Sweeney CJ, Zhu J, Sandler AB, Schiller J, Belani CP, Langer C, Krook J, Harrington D, Johnson DH (2001) Outcome of patients with a performance status of 2 inEastern Cooperative Oncology Group Study E1594: a Phase II trial in patients withmetastatic nonsmall cell lung carcinoma. Cancer 92:2639–2647CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical Oncology DepartmentSBU Antalya Education and Research HospitalMuratpaşa/AntalyaTurkey
  2. 2.Medical Oncology Division, Pendik Education and Research HospitalMarmara University, School of MedicinePendik/IstanbulTurkey
  3. 3.Medical Oncology DivisionAkdeniz University HospitalAntalyaTurkey
  4. 4.Medical Oncology DivisionHacettepe University Oncology HospitalAltındağ/AnkaraTurkey

Personalised recommendations