Carboplatin—etoposide combination in small cell lung cancer patients older than 70 years: a phase II trial

Larivé, Sébastien; Bombaron, P.; Riou, R; Fournel, P.; Pérol, Maurice; Léna, H.; Dussopt, C.; Philip-Joët, F.; Touraine, F; Lecaer, H.; Souquet, Pierre Jean

doi:10.1016/s0169-5002(01)00288-4

Cited by 37 publications

(30 citation statements)

References 23 publications

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“…The CE regimen, which has acceptable toxicities and reproducible efficacy, has been used in elderly or poor-risk patients with SCLC worldwide, although there have been substantial differences in toxicities and efficacy between the reported phase II trials. Four trials demonstrated both favourable toxicities and efficacy (Carney, 1995;Evans et al, 1995;Matsui et al, 1998;Okamoto et al, 1999) and three showed somewhat disappointing results because of suboptimal doses of oral etoposide (Larive et al, 2002), greater inclusion of patients with poor prognostic factors (Samantas et al, 1999), and deterioration of comorbidities as a result of chemotherapy (Quoix et al, 2001). No phase III trial evaluating the role of the CE regimen in this population has been reported until now.…”

Section: Discussionmentioning

confidence: 99%

Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in elderly or poor-risk patients with extensive disease small-cell lung cancer: JCOG 9702

et al. 2007

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We compared the efficacy and the safety of a carboplatin plus etoposide regimen (CE) vs split doses of cisplatin plus etoposide (SPE) in elderly or poor-risk patients with extensive disease small-cell lung cancer (ED-SCLC). Eligibility criteria included: untreated ED-SCLC; age X70 and performance status 0 -2, or age o70 and PS 3. The CE arm received carboplatin area under the curve of five intravenously (IV) on day 1 and etoposide 80 mg m À2 IV on days 1 -3. The SPE arm received cisplatin 25 mg m À2 IV on days 1 -3 and etoposide 80 mg m À2 IV on days 1 -3. Both regimens were given with granulocyte colony-stimulating factor support in a 21 -28 day cycle for four courses. A total of 220 patients were randomised. Median age was 74 years and 74% had a PS of 0 or 1. Major grade 3 -4 toxicities were (%CE/%SPE): leucopenia 54/51, neutropenia 95/90, thrombocytopenia 56/16, infection 7/6. There was no significant difference (CE/SPE) in the response rate (73/73%) and overall survival (median 10.6/9.9 mo; P ¼ 0.54). Palliation scores were very similar between the arms. Although the SPE regimen is still considered to be the standard treatment in elderly or poor-risk patients with ED-SCLC, the CE regimen can be an alternative for this population considering the risk -benefit balance.

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Section: Discussionmentioning

confidence: 99%

Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in elderly or poor-risk patients with extensive disease small-cell lung cancer: JCOG 9702

et al. 2007

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“…Several phase II clinical trials have tested the efficacy of lower dose combinations of concurrent carboplatin and etoposide regimens in elderly SCLC patients [23–26]. Despite some differences in treatment schedule and dosing, three of these studies reported similar survival results as the usual treatment regimen, with a median survival of 41–46 weeks.…”

Section: Discussionmentioning

confidence: 99%

Uptake and Tolerance of Chemotherapy in Elderly Patients with Small Cell Lung Cancer and Impact on Survival

Fisher

Alfayea

Winget

et al. 2012

Journal of Cancer Epidemiology

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The treatment of elderly cancer patients is complicated by many factors. We sought to assess the uptake and tolerance of chemotherapy among patients 75 years and older diagnosed with small cell lung cancer (SCLC) in years 2004–2008 in Alberta, Canada, and assess their survival. All patients who met the above criteria and had an oncologist-consult were included. Data were obtained from the Alberta Cancer Registry and chart review. A total of 171 patients were included in the study, 117 (68%) of whom began chemotherapy. Of those, 52% completed all cycles, 66% did not have any dose reductions, and 31% completed all cycles at the recommended dose. The risk of death for patients who did not complete all cycles of chemotherapy was 2.72 (95% CI: 1.52–4.87) and for those who completed all cycles but with a reduced dose was 1.02 (95% CI: 0.57–1.82) relative to those who completed chemotherapy at full dose after adjusting for several demographic/clinical factors. Our results suggest that a significant proportion of elderly patients are able to tolerate chemotherapy and receive a survival benefit from it while those who experience toxicity may receive a survival benefit from a reduction in chemotherapy dose as opposed to stopping treatment.

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“…There have been phase II trials reported in literature [58][59][60][61][62][63][64] with carboplatin as an alternative to cisplatin given with etoposide in elderly unfit patients with either LS or ES SCLC. This showed statistically comparable response rates to PE with acceptable toxicity ( Table 3).…”

Section: Trials Of Carboplatin/etoposide Doublet For Poor Performancementioning

confidence: 99%

A Review of the Treatment Strategies for Small Cell Lung Carcinoma Patients with a Poor Performance Status

Rehman¹,

Baka²,

Lau³

et al. 2006

CRMR

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Lung cancer is one of the commonest malignancies worldwide and the incidence continues to increase. Small cell lung cancer accounts for approximately 15% of all lung cancer cases although incidence of this subtype appears to be falling. It is an aggressive malignancy but responds well to chemotherapy and radiotherapy. The prognosis for untreated small cell lung cancer is less than 3 months. Small cell lung carcinoma is considered to be either limited-stage (LS) or extensive-stage (ES) on the basis of anatomical staging. In spite of high initial response rates in both limited-and extensive-stage patients, the relapse rate is high and overall median survival in LS and ES is 18 months and 9 months respectively. Standard chemotherapy regimens for small cell lung cancer patients with good performance status are platinum based, the commonest being cisplatin/etoposide. However, many patients present with a poor performance status (ECOG performance status of 2 or more and Karnofsky performance status of 60 or less) and these patients are at higher risk of toxicity from chemotherapy. Furthermore, the lung cancer population is largely elderly, 40% of patients being over 75 years. Whilst age is not an independent poor prognostic factor in itself, 90% of older patients have co-morbidity and may be at increased risk of toxicity due to functional organ impairment. Most clinical trials do not include patients with poor performance status and also the elderly (more than 70 years of age) tend to be under-represented, therefore not really reporting on the elderly. This review summarizes the evidence for treating small cell lung carcinoma patients with a poor performance in order to guide clinical decision-making. Treatment decisions should reflect not only the prognostic groups but take into account performance status and co-morbidities as well. It is important to differentiate between poor performance due to comorbidities and that due to the aggressive nature of small cell carcinoma. In the latter case a patient may have been previously fit and well and compromise on treatment based solely on poor performance may not be desirable, as the performance may improve dramatically if patient responds well to treatment.

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Carboplatin—etoposide combination in small cell lung cancer patients older than 70 years: a phase II trial

Cited by 37 publications

References 23 publications

Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in elderly or poor-risk patients with extensive disease small-cell lung cancer: JCOG 9702

Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in elderly or poor-risk patients with extensive disease small-cell lung cancer: JCOG 9702

Uptake and Tolerance of Chemotherapy in Elderly Patients with Small Cell Lung Cancer and Impact on Survival

A Review of the Treatment Strategies for Small Cell Lung Carcinoma Patients with a Poor Performance Status

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