Abstract
Background: Some evidence suggests that cisplatin-based chemotherapy doublet regimens are more effective than the less toxic carboplatin-based doublet regimens for patients with advanced non-small cell lung cancer (NSCLC), but their effectiveness among elderly cancer patients who are treated in usual care settings is not known. Methods: We identified 13,406 elderly Medicare patients who were diagnosed with stage IV NSCLC between the years 1995-2007 in SEER regions and treated with either a cisplatin-based or a carboplatin-based doublet chemotherapy regimen in the subsequent six months. Using propensity score weighting, we balanced the two treatment cohorts with respect to observable attributes. We then estimated survival and morbidity according to treatment. Findings: Overall, patients treated with cisplatin-based doublets lived two weeks longer on average than patients treated with carboplatin-based doublets (i.e., 7.4 months vs. 7.0 months, p=0.05). For patients >70 years of age, first-line therapy with cisplatin-based doublet chemotherapy regimens was associated with increased post-treatment morbidity and lack of survival advantage compared to carboplatin-based doublet therapies. Interpretations: For patients >70 years of age first-line therapy with carboplatinbased doublet chemotherapy regimens are preferable to cisplatin-based doublet therapies given the similar survival and lower risk of hospitalization.
Highlights
Lung cancer is the second most common cancer in both men and women in the United States (US), the leading cause of cancer death for men and women, and arguably a disease of the elderly [1]
In an effort to provide useful evidence for decision-making for oncologists and their patients with non-small cell lung cancer (NSCLC) who are elderly, we studied observational data to estimate differences in morbidity and mortality between first-line cisplatin-based and carboplatinbased doublet chemotherapy regimens in elderly Medicare patients with advanced NSCLC who are treated in the usual care setting
Patients who were treated with cisplatin-based doublet chemotherapy regimens were observed to use more (1) hospital-based health care and (2) more intensive hospitalbased care following the beginning of chemotherapy than patients who were treated with carboplatin-based doublets
Summary
Lung cancer is the second most common cancer in both men and women in the United States (US), the leading cause of cancer death for men and women, and arguably a disease of the elderly [1]. Over the last thirty years, randomized clinical trials (RCTs) have established that treatment with chemotherapy both improves quality of life and extends survival over best supportive care alone in patients with advanced non-small cell lung cancer (NSCLC), which is the most common form of lung cancer in the US [2]. Among platinum-based doublets regimens, there is ambiguity in clinical oncology about which platinum-containing drug (i.e., cisplatin or carboplatin) confers the greatest benefit. Some evidence suggests that cisplatin-based chemotherapy doublet regimens are more effective than the less toxic carboplatin-based doublet regimens for patients with advanced non-small cell lung cancer (NSCLC), but their effectiveness among elderly cancer patients who are treated in usual care settings is not known
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