Abstract
BackgroundThere have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear. The objective of this study was to identify factors that predicted the survival benefit of chemotherapy.MethodsAll consecutive elderly patients (≥75 years) with advanced NSCLC, Eastern Cooperative Oncology Group PS ≥2, EGFR mutation wild type/unknown, and newly diagnosed from January 2009 to December 2012 at a tertiary hospital were retrospectively reviewed.ResultsWe enrolled 59 patients, and 31 patients received at least one chemotherapy regimen (chemotherapy group). However, 28 patients received best supportive care (BSC) alone (BSC group). The proportion of PS 2 and serum albumin levels was significantly higher in the chemotherapy group than in the BSC group. In the chemotherapy group, log-rank testing did not show statistically significant differences in overall survival (OS) between the single-agent therapy group and carboplatin-based doublet therapy group; however, the OS of patients receiving chemotherapy for only 1 cycle (early termination) was significantly shorter than patients receiving chemotherapy for ≥2 cycles. Hypoalbuminemia was not only a risk factor for the early termination of chemotherapy but also an independent prognostic factor in the chemotherapy group. A receiver operating characteristic curve analysis showed that the best cut-off value was 3.40 g/dL. In patients with serum albumin levels ≥3.40 g/dL, OS was significantly better in the chemotherapy group than in the BSC group (p = 0.0156), however, patients with serum albumin levels <3.40 g/dL exhibited poor prognosis regardless of the presence or absence of chemotherapy.ConclusionIn the elderly NSCLC patients with poor PS, serum albumin levels may help identify certain patient populations more likely to receive a survival benefit of systemic chemotherapy.
Highlights
There have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear
Among patients newly diagnosed with non-small cell lung cancer (NSCLC) in developed countries, approximately 50% are ≥70 years at the time of diagnosis [1], and 30%– 40% are with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2 [2]
The proportion of PS 2, lymphocyte count, and serum albumin level were significantly higher in the chemotherapy group than in the best supportive care (BSC) group
Summary
There have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear. Grade ≥ 3 neutropenia and treatmentrelated death was more common with carboplatin plus weekly paclitaxel compared with single-agent therapy Based on these trial results, single-agent therapy (docetaxel, gemcitabine, or vinorelbine) was recommended as first-line treatment for elderly, advanced NSCLC patients without known driver mutations, and carboplatin-based doublet therapy may be a viable option in patients deemed able to tolerate such therapy. We retrospectively reviewed consecutive elderly patients (≥75 years of age) with advanced NSCLC and with poor PS (ECOG PS ≥ 2) to identify factors that predict the survival benefit of cytotoxic chemotherapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
