Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small cell lung cancer in the United States

Lang, Kathleen; Marciniak, Martin; Faries, D; Stokes, Michael; Buesching, Don P.; Earle, Craig C.; Treat, Joseph; Morissette, N.; Thompson, David R.

doi:10.1016/j.lungcan.2008.05.003

Cited by 52 publications

(55 citation statements)

References 18 publications

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“…Elderly patients have more co-morbid diseases and tend to tolerate toxic medical treatments more poorly than their younger counterparts. Recently, however, clinical trials of platinum-based chemotherapy for selected elderly patients with good condition have been conducted, attracting attention to the utility of such therapy for the elderly (1,2). Assessment of renal function is a daily clinical task, particularly in geriatric practice.…”

Section: Introductionmentioning

confidence: 99%

Age-dependent decline in renal function in patients with lung cancer

et al. 2012

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Abstract. The aim of this study was to clarify the effect of aging on renal function. Serum creatinine (SCr), blood urea nitrogen (BUN) and 24-h creatinine clearance (measuredCrCl) were examined in lung cancer patients and the measured-CrCl were compared with CrCl estimates by employing two commonly used equations. In total, 787 lung cancer patients who were diagnosed between 2001 and 2010 were retrospectively analyzed. SCr and urine creatinine, BUN and measured-CrCl were evaluated prior to treatment. The Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulae were also used to estimate CrCl. SCr, BUN and measured-CrCl showed a significant decline in the elderly. In the 787 lung cancer patients, a significant correlation coefficient was found between measured-CrCl and age. However, in patients aged 80 years or older, no significant correlation coefficient was found between measured-CrCl and age. In the comparison between the measured CrCl and the CrCls estimated by the two formulae, the CG-CrCl levels were lower than those of the measured-CrCl, whereas the MDRDCrCl levels were higher. Age is a crucial factor influencing renal function in patients with lung cancer. Particularly in the elderly, a decline in CrCl and greater individual variability in CrCl, as well as discrepancies in measured-CrCl and estimated CrCls are significant factors.

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Section: Introductionmentioning

confidence: 99%

Age-dependent decline in renal function in patients with lung cancer

et al. 2012

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“…Results from a number of published studies have shown that rates of chemotherapy treatment are low in elderly patients [4][5][6][7][8] . Several factors have been found to be associated with chemotherapy treatment not being started, including diagnosis of stage iiib or iv nsclc, age, and multiple comorbidities [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Several factors have been found to be associated with chemotherapy treatment not being started, including diagnosis of stage iiib or iv nsclc, age, and multiple comorbidities [4][5][6][7][8] . Regardless, some studies have shown that chemotherapy treatment in the elderly may be beneficial.…”

Section: Introductionmentioning

confidence: 99%

Survival and Treatment Patterns in Elderly Patients with Advanced Non-Small-Cell Lung Cancer in Manitoba

et al. 2011

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Lung cancer is the leading cause of cancer death worldwide. Non-small-cell lung cancer (nsclc) is the most common form of lung cancer, with a median age at diagnosis of 70 years. These elderly patients are often underrepresented in the randomized clinical trials upon which chemotherapy plans are based. The objective of the present study was to determine the patterns of treatment and survival in elderly patients with advanced nsclc in Manitoba. An eligible cohort of elderly patients over 70 years of age at diagnosis (n = 497) with advanced nsclc was identified from the provincial cancer registry database for the period 2001–2004. Of the 497 patients identified, only 147 had been evaluated by a medical oncologist, and 82 of the 147 had received chemotherapy treatment, which is 16.5% of the initial cohort. Patients who received chemotherapy were younger than those who did not receive chemotherapy. Most patients receiving chemotherapy (84%) received doublet chemotherapy, with an almost equal split between cisplatin and carboplatin treatment. The median survival times for patients in this cohort were 64 weeks (stage iii nsclc) and 56 weeks (stage iv) with chemotherapy treatment, and 46 weeks (stage iii) and 26 weeks (stage iv) without chemotherapy. Although 50% of patients with advanced nsclc are more than 70 years of age, few are evaluated by a medical oncologist and even fewer are treated with chemotherapy. However, it should be noted that, in the elderly patients who were treated, survival times are comparable to those experienced by younger patients, which is indicative of a benefit of chemotherapy treatment for those elderly patients.

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“…However, it has become useful in recent years, due to the fact that chemotherapy with a third-generation agent (gemcitabine, taxane or vinorelbine) has significantly improved median survival and quality of life in those patients (3,(8)(9)(10). In the USA, 28% of elderly stage IIIB/IV NSCLC patients diagnosed in 1997 were administered chemotherapy, which increased to 36% of patients diagnosed in 2002 (11). Combination chemotherapy is used with caution in elderly patients due to the high risk of adverse events and a lower ability to tolerate the potential toxicity, thus single agents are generally accepted by oncologists as first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

Pemetrexed versus vinorelbine treatment of advanced non-squamous non-small cell lung cancer in elderly patients

Chen

Wen

Líu³

et al. 2013

Molecular and Clinical Oncology

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Abstract. Pemetrexed, a multitargeted antifolate agent, has been shown to have clear activity in non-squamous non-small cell lung cancer (NSCLC). The aim of this retrospective studywas to evaluated the efficacy and toxicity of pemetrexed vs. vinorelbine in NSCLC elderly patients. Chemotherapy-naive patients aged ≥70 years with stage IIIB/IV non-squamous NSCLC and performance status ≤2 were eligible for inclusion in this study. Patients were selected to receive pemetrexed 500 mg/m 2 (day 1) or vinorelbine 25 mg/m 2 (days 1 and 8) every 21 days. In total, 62 patients were enrolled in the present study. Thirty-six patients were treated with pemetrexed, and 26 with vinorelbine. The median number of cycles received was six in the pemetrexed group vs. four in the vinorelbine group. Pemetrexed demonstrated a significantly higher disease control rate (DCR) (80.5 vs. 65.3%; P=0.011), and an improvement in progression-free survival (6.5 vs. 4.0 months; P=0.018) compared to vinorelbine. Neutropenia occurred in more patients in the vinorelbine group compared to the pemetrexed group, grade 3-4 neutropenia was observed in 53.8 and 11.1% of patients in the two groups, respectively (P<0.001). Pemetrexed-treated patients experienced lower frequencies of anemia, thrombocytopenia and non-hematologic toxicities compared to vinorelbine-treated patients. The toxicity profiles for the two treatment groups were mild and tolerable. In conclusion, pemetrexed improved DCR, progression-free survival, and presented a lower incidence of treatment-related adverse events compared to vinorelbine, although overall survival was not significantly improved. As a result, pemetrexed monotherapy might be considered as a good option in the treatment of elderly patients with advanced non-squamous NSCLC.

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Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small cell lung cancer in the United States

Cited by 52 publications

References 18 publications

Age-dependent decline in renal function in patients with lung cancer

Age-dependent decline in renal function in patients with lung cancer

Survival and Treatment Patterns in Elderly Patients with Advanced Non-Small-Cell Lung Cancer in Manitoba

Pemetrexed versus vinorelbine treatment of advanced non-squamous non-small cell lung cancer in elderly patients

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