Vinorelbine in elderly patients with inoperable nonsmall cell lung carcinoma

Abstract

BACKGROUND Cancer in the elderly is becoming a complex and frequent issue. At least 30% of lung carcinomas are expected to arise each year in elderly patients, who often have significant comorbidity. The most appropriate treatment for this large portion of cancer patients remains unknown. The purpose of this Phase II trial was to make a comprehensive evaluation of the activity, toxicity, and tolerability of single‐agent vinorelbine in elderly and relatively poorly performing patients with inoperable nonsmall cell lung carcinoma (NSCLC). METHODS Patients age 70 years or older were eligible to participate in this trial if they had a pathologic diagnosis, a performance status lower than 4 (Eastern Cooperative Oncology Group [ECOG] scale), and gave informed consent. Vinorelbine was given intravenously (i.v.) at a dose of 25 mg/m2 every week until progression, persistent toxicity, or refusal. RESULTS Forty‐six patients entered the study; their median age was 75 years (range, 70–83 years). Five patients never started on vinorelbine; 27 others had early treatment suspensions. The median number of weekly infusions was 5 (range, 0–28); the median dose intensity was 70% of projected. Toxicity was generally mild, mainly hematologic, and never life‐threatening. ECOG performance status, body weight, and almost all the scores from the quality‐of‐life questionnaires remained constant during the first 6 weeks of treatment. Two patients obtained partial response, 10 patients had some tumor regression, and 26 had tumor stabilization. The estimated median time to progression was 19 weeks (quartile range, 11–23 weeks), and the median survival 34 weeks (quartile range, 16–63 weeks). CONCLUSIONS In our group of patients who had poor prognoses, vinorelbine was well tolerated, moderately active, and capable of ensuring relatively long survival. It may represent a valuable therapeutic option for the treatment of nonresectable NSCLC in elderly patients. Cancer 2000;88:2677–85. © 2000 American Cancer Society.

Front-line weekly chemotherapy with gemcitabine for unfit patients with non-small cell lung cancer (NSCLC)

“…The median survival of our patients was 35 weeks, after gemcitabine. This figure is similar to that usually reported by authors who used the single GEM or GEM plus VNB in the elderly patients [13][14][15]28], or in an our previous report regarding the use of VNB in elderly or unfit patients [27]. Toxicity was mild and less serious than previously reported.…”

“…Recent reports indicate that single agent therapy with vinorelbine [25][26][27], gemcitabine [13][14][15] or together [15] may obtain a response rate of 20-30% in elderly patients, with acceptable toxicity and improvement in symptoms and quality of life. Bianco et al [13] enrolled 52 previously untreated elderly patients with advanced/metastatic NSCLC.…”

Anthropometric measurements in non-small-cell lung cancer

“…As could have been foreseen, only a relatively small proportion of patients could be operated on (19% of the cohort). Chemotherapy was the most frequent treatment, in keeping with our early recognition of its potential benefit [7,8,9], either alone or in combination with other treatment modalities (53% of the population). The remaining patients received supportive care only (25%), while curative radiotherapy was performed in only 3% of the subjects.…”

Prognostic significance of blood coagulation tests in lung cancer

“…As expected, only a relatively small fraction of patients could be treated surgically (19% of the cohort). Chemotherapy was the most frequent treatment, in accordance with the early recognition of its potential bene®t [14,15] either alone or in combination (51% of the population). Curative radiotherapy was attempted in only 2% of the cases; the remaining patients received the best supportive care (26%).…”