1220 - Doublet versus SINGLE Cytotoxic Agent as First-Line Treatment for Elderly Patients with Advanced Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract

ABSTRACT The standard treatment for elderly patients with advanced non-small cell lung cancer (NSCLC) is still debated. As a result, we performed a meta-analysis of all randomized controlled trials comparing the efficacy of doublet versus single third-generation cytotoxic agent in the elderly patients with advanced NSCLC. Finally, eight eligible trials involved 2108 patients were identified. The intention to treatment (ITT) analysis demonstrated that doublet therapy significantly improved OS (HR0.85 95%CI 0.72-1.00, p = 0.048), PFS (HR 0.72, 95%CI 0.55-0.93, p = 0.012), 1-year SR (RR 1.18, 95%CI 1.02-1.36, p = 0.027) and ORR (RR1.65,95%CI 1.36-1.99, p = 0.000), compared with single cytotoxic agent. Sub-group analysis also favored platinum-based doublet therapy in terms of OS, PFS/TTP, 1-year SR and ORR. Though gemcitabine-based doublet significantly increased ORR compared with single agent (RR1.51, 95%CI 1.21-1.87, p = 0.000), it did not translate into increase in survival benefits in terms of OS, PFS and 1-year SR. More incidences of grade 3 or 4 hematologic toxicities were observed in doublet therapy group. With respect to grade 3 or 4 non-hematologic toxicities, equivalent frequencies were found between groups excluding more incidence of neutrotoxicity in doublet therapy group. Our data indicated that doublet therapy was superior to single third-generation cytotoxic agent for elder patients with advanced NSCLC. The optimal drug dosage and treatment schedule of platinum-based doublet should be investigated in future prospective clinical trials. Gemcitabine-based doublet could be considered for elderly patients who were not suitable for platinum-based chemotherapy. Disclosure All authors have declared no conflicts of interest.