(ChemotherapyAdvisor) – Among elderly patients with advanced non-small cell lung cancer (NSCLC), first-line chemotherapy regimens that employ two cytotoxic drugs are associated with better survival times than those involving a single drug, according to a meta-analysis presented at the European Society for Medical Oncology (ESMO) annual meeting in Vienna, Austria.
The study pooled data from eight randomized, controlled clinical trials, representing a total of 2,108 elderly NSCLC patients.
“Our data indicated that doublet therapy was superior to single third-generation cytotoxic agent for elder patients with advanced NSCLC,” reported Wei-Xiang Qi of the Department of Oncology at Shanghai Jiao Tong University in Shanghai, China, and coauthors. “The optimal drug dosage and treatment schedule of platinum-based doublet (therapies) should be investigated in future prospective clinical trials. Gemcitabine-based doublet could be considered for elderly patients who were not suitable for platinum-based chemotherapy.”
Overall, 2-cytotoxic-agent therapies were associated with longer survival rates than single-agent therapies for both OR (overall survival) and progression-free survival (PFS): OR (HR 0.85 [95% CI: 0.72-1.00]; P = 0.048), PFS (progression-free survival; HR 0.72 [95% CI: 0.55-0.93]; P = 0.012), 1-year survival rate (RR 1.18 [95% CI: 1.02-1.36]; P = 0.027) and ORR (overall response rate; RR 1.65 [95% CI: 1.36-1.99]; p < 0.001), the authors reported.
“Sub-group analysis also favored platinum-based doublet therapy in terms of OS, PFS/TTP, 1-year SR (survival rate) and ORR,” Dr. Qi and colleagues reported. “Though gemcitabine-based doublet significantly increased ORR compared with single agent, it did not translate into increase in survival benefits in terms of OS, PFS and 1-year survival rate.”
Two-agent regimens were associated with improved response rates and survival rates, but were also associated with higher rates of grade 3 and 4 hematologic toxicities.
Grade 3 or 4 non-hematologic adverse events overall were not significantly different between patients receiving a single-agent chemotherapy and those receiving doublet treatment, the team reported.
ESMO Abstract (#1220)