Chemotherapy for advanced non-small-cell lung cancer patients with poor performance

Abstract

Evaluation of: Morère JF, Bréchot JM, Westeel V et al. Randomized Phase II trial of gefitinib or gemcitabine or docetaxel chemotherapy in patients with advanced non-small-cell lung cancer and a performance status of 2 or 3 (IFCT-0301 study). Lung Cancer DOI: 10.1016/j.lungcan.2010.03.003 (2010) (Epub ahead of print).Previous studies have recommended single-agent chemotherapy as an important alternative for non-small-cell lung cancer (NSCLC) patients with old age or poor performance. The authors of the evaluated article have evaluated three treatment strategies within the Intergroupe Francophone de Cancérologie Thoracique (IFCT-0301 study) as a Phase II trial. All strategies started with single-agent chemotherapy in chemotherapy-naive NSCLC patients with performance status (PS) 2 or 3. The three agents used for initial therapy in this study were gefitinib, gemcitabine and docetaxel. All three agents showed similar median progression-free survival values. Docetaxel was associated with higher response rates but also higher rates of adverse events. In subgroup analysis, patients with PS 3 did not benefit from monotherapy. This study suggests that monotherapy is still an option for NSCLC patients with PS 2; but, the study was not powered to favor one agent out of the three. In addition, because the study population did not undergo EGF receptor mutation analysis, it may not reflect the therapeutic impact of EGF receptor inhibitors, which can be tolerable in patients of poor performance.