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For elderly patients with advanced non-small cell lung cancer (NSCLC), treatment with a combination of two chemotherapy drugs results in better overall survival than treatment with single-agent chemotherapy. The results of this Phase III clinical trial were published in The Lancet.

Lung cancer remains the leading cause of cancer death in the United States. Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers.

Many NSCLC cases occur in people over the age of 70, but there is limited information about how best to treat older patients. As a result of the limited information and concern that elderly patients will not be able to tolerate aggressive treatment, older patients may be treated with single-agent chemotherapy rather than the combination chemotherapy that is commonly used in younger patients.

To explore treatment options for older patients with advanced NSCLC, researchers in France conducted a Phase III clinical trial in 451 patients between the ages of 70 and 89. Patients were assigned to receive either combination chemotherapy with paclitaxel and carboplatin, or single-agent chemotherapy with gemcitabine or vinorelbine.

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  • Overall survival was 10.3 months among patients treated with combination chemotherapy and 6.2 months among patients treated with single-agent chemotherapy.
  • 44.5% of patients treated with combination chemotherapy survived for at least one year, compared with 25.4% of patients treated with single-agent chemotherapy.
  • Side effects such as a low white blood cell count and weakness were more common with combination chemotherapy.

These results suggest that older patients with advanced NSCLC can be considered for the same aggressive therapy as younger patients. More aggressive therapy increases side effects but may also improve survival. Because relatively few studies have focused on older lung cancer patients, however, additional research on this issue is warranted.

Reference: Quoix E, Zalcman G, Oster J-P et al. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. The Lancet. Early online publication August 9, 2011.

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