Elderly patients benefit from second-line cytotoxic chemotherapy

A subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer

Glen J. Weiss, Corey Langer, Rafael Rosell, Nasser Hanna, Frances Shepherd, Lawrence Einhorn, Binh Nguyen, Sofia Paul, Patrick McAndrews, Paul A. Bunn, Karen Kelly

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

Purpose: Numerous prospective and retrospective studies have concluded that elderly patients (≥ 70 years old) achieve a similar survival benefit, with acceptable toxicity, from first-line cytotoxic chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) compared with their younger counterparts. However, few published data exist on the efficacy and tolerability of second-line cytotoxic therapy in this population. Patients and Methods: Retrospective analysis of a large second-line trial was performed. Data from 571 patients randomly assigned to docetaxel 75 mg/m2 or pemetrexed 500 mg/m2 every 3 weeks were analyzed for efficacy and toxicity comparisons between age groups and treatment arms. Results: Eighty-six of 571 patients (15%) were ≥ 70 years old, similar to rates of elderly observed in the first-line setting. Elderly patients receiving pemetrexed (n = 47) or docetaxel (n = 39) had a median survival of 9.5 and 7.7 months compared with 7.8 and 8.0 months for younger patients receiving pemetrexed (n = 236) or docetaxel (n = 249), respectively. Elderly patients treated with pemetrexed had a longer time to progression and a longer survival than their counterpart patients treated with docetaxel (not statistically significant). Febrile neutropenia was less frequent in elderly patients treated with pemetrexed (2.5%) compared with docetaxel (19%; P = .025), with only one death as a result of toxicity (docetaxel arm). Conclusion: Elderly patient participation was similar to rates observed in the first-line setting. There was no significant difference in outcome or toxicity between elderly and younger patients. For elderly patients with advanced NSCLC and good performance status, second-line cytotoxic therapy is appropriate. In this subset, pemetrexed produced a more favorable toxicity profile.

Original languageEnglish (US)
Pages (from-to)4405-4411
Number of pages7
JournalJournal of Clinical Oncology
Volume24
Issue number27
DOIs
StatePublished - Sep 20 2006
Externally publishedYes

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docetaxel
Pemetrexed
Non-Small Cell Lung Carcinoma
Drug Therapy
Survival
Patient Participation
Febrile Neutropenia

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Elderly patients benefit from second-line cytotoxic chemotherapy : A subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer. / Weiss, Glen J.; Langer, Corey; Rosell, Rafael; Hanna, Nasser; Shepherd, Frances; Einhorn, Lawrence; Nguyen, Binh; Paul, Sofia; McAndrews, Patrick; Bunn, Paul A.; Kelly, Karen.

In: Journal of Clinical Oncology, Vol. 24, No. 27, 20.09.2006, p. 4405-4411.

Research output: Contribution to journalArticle

Weiss, Glen J. ; Langer, Corey ; Rosell, Rafael ; Hanna, Nasser ; Shepherd, Frances ; Einhorn, Lawrence ; Nguyen, Binh ; Paul, Sofia ; McAndrews, Patrick ; Bunn, Paul A. ; Kelly, Karen. / Elderly patients benefit from second-line cytotoxic chemotherapy : A subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 27. pp. 4405-4411.
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abstract = "Purpose: Numerous prospective and retrospective studies have concluded that elderly patients (≥ 70 years old) achieve a similar survival benefit, with acceptable toxicity, from first-line cytotoxic chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) compared with their younger counterparts. However, few published data exist on the efficacy and tolerability of second-line cytotoxic therapy in this population. Patients and Methods: Retrospective analysis of a large second-line trial was performed. Data from 571 patients randomly assigned to docetaxel 75 mg/m2 or pemetrexed 500 mg/m2 every 3 weeks were analyzed for efficacy and toxicity comparisons between age groups and treatment arms. Results: Eighty-six of 571 patients (15{\%}) were ≥ 70 years old, similar to rates of elderly observed in the first-line setting. Elderly patients receiving pemetrexed (n = 47) or docetaxel (n = 39) had a median survival of 9.5 and 7.7 months compared with 7.8 and 8.0 months for younger patients receiving pemetrexed (n = 236) or docetaxel (n = 249), respectively. Elderly patients treated with pemetrexed had a longer time to progression and a longer survival than their counterpart patients treated with docetaxel (not statistically significant). Febrile neutropenia was less frequent in elderly patients treated with pemetrexed (2.5{\%}) compared with docetaxel (19{\%}; P = .025), with only one death as a result of toxicity (docetaxel arm). Conclusion: Elderly patient participation was similar to rates observed in the first-line setting. There was no significant difference in outcome or toxicity between elderly and younger patients. For elderly patients with advanced NSCLC and good performance status, second-line cytotoxic therapy is appropriate. In this subset, pemetrexed produced a more favorable toxicity profile.",
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T2 - A subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer

AU - Weiss, Glen J.

AU - Langer, Corey

AU - Rosell, Rafael

AU - Hanna, Nasser

AU - Shepherd, Frances

AU - Einhorn, Lawrence

AU - Nguyen, Binh

AU - Paul, Sofia

AU - McAndrews, Patrick

AU - Bunn, Paul A.

AU - Kelly, Karen

PY - 2006/9/20

Y1 - 2006/9/20

N2 - Purpose: Numerous prospective and retrospective studies have concluded that elderly patients (≥ 70 years old) achieve a similar survival benefit, with acceptable toxicity, from first-line cytotoxic chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) compared with their younger counterparts. However, few published data exist on the efficacy and tolerability of second-line cytotoxic therapy in this population. Patients and Methods: Retrospective analysis of a large second-line trial was performed. Data from 571 patients randomly assigned to docetaxel 75 mg/m2 or pemetrexed 500 mg/m2 every 3 weeks were analyzed for efficacy and toxicity comparisons between age groups and treatment arms. Results: Eighty-six of 571 patients (15%) were ≥ 70 years old, similar to rates of elderly observed in the first-line setting. Elderly patients receiving pemetrexed (n = 47) or docetaxel (n = 39) had a median survival of 9.5 and 7.7 months compared with 7.8 and 8.0 months for younger patients receiving pemetrexed (n = 236) or docetaxel (n = 249), respectively. Elderly patients treated with pemetrexed had a longer time to progression and a longer survival than their counterpart patients treated with docetaxel (not statistically significant). Febrile neutropenia was less frequent in elderly patients treated with pemetrexed (2.5%) compared with docetaxel (19%; P = .025), with only one death as a result of toxicity (docetaxel arm). Conclusion: Elderly patient participation was similar to rates observed in the first-line setting. There was no significant difference in outcome or toxicity between elderly and younger patients. For elderly patients with advanced NSCLC and good performance status, second-line cytotoxic therapy is appropriate. In this subset, pemetrexed produced a more favorable toxicity profile.

AB - Purpose: Numerous prospective and retrospective studies have concluded that elderly patients (≥ 70 years old) achieve a similar survival benefit, with acceptable toxicity, from first-line cytotoxic chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) compared with their younger counterparts. However, few published data exist on the efficacy and tolerability of second-line cytotoxic therapy in this population. Patients and Methods: Retrospective analysis of a large second-line trial was performed. Data from 571 patients randomly assigned to docetaxel 75 mg/m2 or pemetrexed 500 mg/m2 every 3 weeks were analyzed for efficacy and toxicity comparisons between age groups and treatment arms. Results: Eighty-six of 571 patients (15%) were ≥ 70 years old, similar to rates of elderly observed in the first-line setting. Elderly patients receiving pemetrexed (n = 47) or docetaxel (n = 39) had a median survival of 9.5 and 7.7 months compared with 7.8 and 8.0 months for younger patients receiving pemetrexed (n = 236) or docetaxel (n = 249), respectively. Elderly patients treated with pemetrexed had a longer time to progression and a longer survival than their counterpart patients treated with docetaxel (not statistically significant). Febrile neutropenia was less frequent in elderly patients treated with pemetrexed (2.5%) compared with docetaxel (19%; P = .025), with only one death as a result of toxicity (docetaxel arm). Conclusion: Elderly patient participation was similar to rates observed in the first-line setting. There was no significant difference in outcome or toxicity between elderly and younger patients. For elderly patients with advanced NSCLC and good performance status, second-line cytotoxic therapy is appropriate. In this subset, pemetrexed produced a more favorable toxicity profile.

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