The efficacy and adverse effects of individualized treatment for elderly patients with epidermal growth factor receptor wild-type non-small cell lung cancer under the guidance of molecular markers

Abstract

To compare the efficacy and toxicity of chemotherapy under the guidance of molecular markers and with vinorelbine in elderly patients with epidermal growth factor receptor (EGFR) wild-type advanced non-small cell lung cancer (NSCLC). A total of 86 elderly patients with pathologically-confirmed advanced NSCLC with EGFR wild-type were recruited between June 2010 to October 2012. There were 69 males and 17 females, aging from 70 to 83 years. They were divided randomly into 2 groups according to the proportion of 1: 1 by SPSS 16.0 software. The study group received chemotherapy (cisplatin, gemcitabine, paclitaxel, and pemetrexed ) under the guidance of molecular markers (excision repair cross-complementing 1 ERCC1, ribonucleotide reductase M1 RRM1, Class III beta-tubulin, thymidylate synthetase TS). The control group received vinorelbine 25 mg/m(2) days 1 and 8 with 21 days as a cycle. The progression-free survival (PFS) of the study group and the control group was 4.0 months (95%CI: 3.1-4.9) and 3.0 months (95% CI: 2.4-3.6 ) respectively, the difference being statistically significant (χ(2) = 4.750, P = 0.029). The objective response rate (ORR) was 23% (10/43) and 19% (8/43) (χ(2) = 0.281, P = 0.596), the disease control rate (DCR) was 79% (34/43) and 77% (33/43) (χ(2) = 0.068, P = 0.795), and the median overall survival (OS) was 8.3 months and 7.5 months (χ(2) = 0.756, P = 0.385), respectively; the differences being not significant. Adverse effects were similar between the study group and the control group. The most commonly seen adverse events were hematological toxicity, nausea, vomiting, fatigue, alopecia, joint and muscle pain. Most of the toxicity was of grade I and grade II. There was no treatment-related death. The PFS was prolonged in elderly patients with EGFR wild-type advanced NSCLC under the guidance of molecular markers, but there was no improvement in ORR, DCR and OS. Further studies are needed to evaluate the clinical significance of this treatment modality.