Chemotherapy of lung cancer in the elderly

Frasci, G.

doi:10.1016/s1040-8428(01)00145-7

Cited by 22 publications

(8 citation statements)

References 46 publications

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“…In addition, the present series was affected by less comorbidities. The adverse impact of the number of associated diseases, summarised by the Charlson score, on survival of elderly NSCLC patients was already demonstrated in our previous study (Frasci, 2002), and it has been confirmed in the present trial. Indeed, MST for patients with a Charlson score X3 was 16 weeks in our previous study, and 4.0 months in the present trial, while it was 23 weeks and 7.6 months, respectively, for patients with a lower score.…”

Section: Discussionsupporting

confidence: 86%

“…We selected these doublets on the ground of their exciting activity demonstrated in our own previous experience Lorusso et al, 2000;Frasci, 2002), as well as in other studies (Isla et al, 2001;Hirsh et al, 2003), while paclitaxel and gemcitabine were identified as single agents to be challenged on the basis of several retrospective and prospective reports about their efficacy and tolerability in NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, this study highlighted that a high Charlson score (X3) was associated with the worst survival, suggesting that a comprehensive geriatric assessment, specifically looking at the type and number of the comorbidities, was mandatory in order to select the patients who may take advantage from a potentially active treatment (Frasci, 2002).…”

mentioning

confidence: 99%

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Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients

Comella

Frasci

Carnicelli³

et al. 2004

Br J Cancer

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The aim of this study was to assess whether a combination of gemcitabine (GEM) with either paclitaxel (PTX) or vinorelbine (VNR) could be more effective than GEM or PTX alone in elderly or unfit advanced non-small-cell lung cancer (NSCLC) patients. A total of 264 NSCLC patients aged 470 years with ECOG performance status (PS)p2, or younger with PS ¼ 2, were randomly treated with: GEM 1200 mg m À2 on days 1, 8 and 15 every 28 days; PTX 100 mg m À2 on days 1, 8 and 15 every 28 days; GEM 1000 mg m À2 plus PTX 80 mg m À2 (GT) on days 1 and 8 every 21 days; GEM 1000 mg m À2 plus VNR 25 mg m À2 (GV) on days 1 and 8 every 21 days. In all arms, an intra-patients dose escalation was applied over the first three courses, provided that no toxicity of WHO grade X2 had previously occurred. At present time, 217 (82%) patients had died. The median (months) and 1-year survival probability were 5.1 and 29% for GEM, 6.4 and 25% for PTX, 9.2 and 44% for GT, and 9.7 and 32% for GV. Multivariate analysis showed that PSp1 (hazard ratio (HR) ¼ 0.67; 95% CI 0.51 -0.90), and doublet treatments (HR ¼ 0.76; 95% CI 0.59 -0.99) were significantly associated with longer survival. Doublets produced no more toxicity than single agents. GT should be considered a reference regimen for elderly NSCLC patients with PSp1.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients

Comella

Frasci

Carnicelli³

et al. 2004

Br J Cancer

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“…It is possible that we cannot demonstrate differences between elderly and younger patients due to exclusion of elderly patients with a poor performance status or comorbidity. Generally, elderly patients are thought to be less able to tolerate polychemotherapy (Frasci, 2002). However, to date prospective randomised trials on the beneficial role of platinum-based chemotherapy in elderly NSCLC patients are not available (Frasci, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Generally, elderly patients are thought to be less able to tolerate polychemotherapy (Frasci, 2002). However, to date prospective randomised trials on the beneficial role of platinum-based chemotherapy in elderly NSCLC patients are not available (Frasci, 2002). Shepherd et al (2000) have shown that second-line treatment with single-agent docetaxel, compared to best supportive care, is associated with prolongation of survival.…”

Section: Discussionmentioning

confidence: 99%

First-line gemcitabine with cisplatin or epirubicin in advanced non-small-cell lung cancer: a phase III trial

Wachters¹,

Putten²,

Kramer³

et al. 2003

Br J Cancer

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The purpose of our study was to compare progression-free survival and quality of life (QOL) after cisplatin -gemcitabine (CG) or epirubicin -gemcitabine (EG) in chemotherapy-naive patients with unresectable non-small-cell lung cancer. Patients (n ¼ 240) were randomised to receive gemcitabine 1125 mg m À2 (days 1 and 8) plus either cisplatin 80 mg m À2 (day 2) or epirubicin 100 mg m À2 (day 1) every 3 weeks for a maximum of five cycles. Eligible patients had normal organ functions and Eastern Cooperative Oncology Group performance status p2. QOL was measured with European Organisation for Research and Treatment of Cancer QLQ-C30 and LC13 questionnaires. There were no significant differences in median progression-free survival (CG 26 weeks, EG 23 weeks), median overall survival (CG 43 weeks, EG 36 weeks), or tumour response rates (CG 46%, EG 36%). Toxicity was mainly haematologic. In the EG arm granulocytopenia occurred more frequently, leading to more febrile neutropenia. Also, elevation of serum transaminases, mucositis, fever, and decline in LVEF were more common in the EG arm. In the CG arm, more patients experienced elevated serum creatinine levels, sensory neuropathy, nausea, and vomiting. Global QOL was not different in both arms. Progression-free survival, overall survival, response rate, and QOL were not different between both arms; however, overall toxicity was more severe in the EG arm.

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Solamargine upregulation of Fas, downregulation of HER2, and enhancement of cytotoxicity using epirubicin in NSCLC cells

Liang

Shiu

Chang

et al. 2007

Molecular Nutrition Food Res

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Nonsmall-cell lung cancer (NSCLC) is not generally a chemosensitive tumor, and the mechanism of resistance to the relevant anticancer drugs has not been fully elucidated. Solamargine (SM), the major steroidal glycoalkaloids extracted from the Chinese herb Solanum, inhibits the growth of human tumor cells. We have previously demonstrated that SM regulates tumor necrosis factor receptors (TNFRs)- and mitochondria-mediated pathways and sensitizes NSCLC cells to initiate apoptosis. Interestingly, this investigation reveals that SM up-regulated Fas expression and down-regulated the expression of HER2, whose overexpression is associated with resistance to drugs, and promotes chemotherapy-induced apoptosis in NSCLC A549 and H441 cells. After treatment with SM, the expression of HER2 mRNA was correlated with the expression of topoisomerase IIalpha (TOP2A) mRNA. The combinatory use of low concentrations of SM with low-toxic topoisomerase II inhibitor epirubicin accelerated apoptotic cell death. Therefore, the downregulation of the HER2 and TOP2A expression by SM with epirubicin may partially explain the SM and epirubicin cytotoxicity synergy effect in NSCLC. Results of this study suggest that SM induces Fas and TNFR-induced NSCLC cell apoptosis and reduces HER2 expression. These findings provide the synergistic therapeutic interaction between SM and epirubicin, suggesting that such combinations may be effectively exploited in future human cancer clinical trials.

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Chemotherapy of lung cancer in the elderly

Cited by 22 publications

References 46 publications

Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients

Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients

First-line gemcitabine with cisplatin or epirubicin in advanced non-small-cell lung cancer: a phase III trial

Solamargine upregulation of Fas, downregulation of HER2, and enhancement of cytotoxicity using epirubicin in NSCLC cells

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