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Weiss GJ , Langer C , Rosell R , Hanna N , Shepherd F , Einhorn LH , Nguyen B , Paul S , McAndrews P , Bunn PA , Kelly K
Elderly patients benefit from second-line cytotoxic chemotherapy: A subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer
JOURNAL OF CLINICAL ONCOLOGY. 2006 Sep;24(27) :4405-4411
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Abstract
Purpose Numerous prospective and retrospective studies have concluded that elderly patients ( 70 years old) achieve a similar survival benefit, with acceptable toxicity, from first-line cytotoxic chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) compared with their younger counterparts. However, few published data exist on the efficacy and tolerability of second-line cytotoxic therapy in this population. Patients and Methods Retrospective analysis of a large second-line trial was performed. Data from 571 patients randomly assigned to docetaxel 75 mg/m(2) or pernetrexed 500 mg/m(2) every 3 weeks were analyzed for efficacy and toxicity comparisons between age groups and treatment arms. Results Eighty-six of 571 patients (15%) were 70 years old, similar to rates of elderly observed in the first-line setting. Elderly patients receiving pemetrexed (n = 47) or docetaxel (n = 39) had a median survival of 9.5 and 7.7 months compared with 7.8 and 8.0 months for younger patients receiving pemetrexed (n = 236) or docetaxel (n = 249), respectively. Elderly patients treated with pemetrexed had a longer time to progression and a longer survival than their counterpart patients treated with docetaxel (not statistically significant). Febrile neutropenia was less frequent in elderly patients treated with pemetrexed (2.5%) compared with docetaxel (19%; P =.025), with only one death as a result of toxicity (docetaxel arm). Conclusion Elderly patient participation was similar to rates observed in the first-line setting. There was no E. significant difference in outcome or toxicity between elderly and younger patients. For elderly patients with advanced NSCLC and good performance status, second-line cytotoxic therapy is appropriate. In this subset, pernetrexed produced a more favorable toxicity profile.
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