Carboplatin-Pemetrexed Followed by Pemetrexed Maintenance Is 'Tolerable and Effective' at Recommended Dose for Elderly Patients with Nonsquamous NSCLC

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(ChemotherapyAdvisor) – Carboplatin plus pemetrexed, followed by maintenance pemetrexed therapy, is a “tolerable and effective” regimen among chemotherapy-naive elderly patients with advanced nonsquamous non-small cell lung cancer (NSCLC), according to a Japanese dose-escalation safety study published in the Annals of Oncology.

A “combination of carboplatin at an AUC (area under the curve) of 5 plus 500 mg/m2 pemetrexed as the recommended dose was confirmed to be reasonably well tolerated and effective for chemotherapy naïve, elderly (≥75 year-old) Japanese patients,” reported M. Tamiya, MD, of the Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, in Habikino City, Osaka, Japan, and coauthors. “Pemetrexed maintenance therapy, following the combination therapy, was well tolerated.”

Elderly people are under-represented in clinical oncology drug trials “and, therefore, might not receive the most appropriate treatment in practice,” the authors noted. Retrospective analyses of data for patients age >70 years from several phase 3 studies of NSCLC treatments, support platinum-based doublet therapy for fit elderly patients and a recent French phase 3 trial established prolonged OS among patients administered carboplatin-paclitaxel for elderly NSCLC patients, they added.

The new study followed up on those phase 3 trials, to determine a safe recommended dose for this regimen among 17 elderly patients with advanced nonsquamous NSCLC, diagnosed at age ≥75 years.

The median progression-free survival (OS) time was 5.1 months (95% CI, 2.4-7.7 months) and overall survival (OS) was 16.5 months (95% CI, 7.7-26.9 months), the team reported. “The study had an overall response rate of 47.1%,” the authors reported.

Carboplatin-pemetrexed followed by pemetrexed “might be similarly effective” for elderly patients as for younger patients with advanced nonsquamous NSCLC, the authors wrote.

Grade 3-4 hematological toxicities included neutropenia (47%), anemia (29%), and thrombocytopenia (35%).

“Few toxic effects were observed during the maintenance period,” the authors noted.

The new study's findings provide “the rationale for larger-scale trials of carboplatin-pemetrexed for elderly patients with advanced nonsquamous NSCLC,” the authors concluded. A multicenter phase 2 trial is underway.


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