Cisplatin plus etoposide in advanced non-small cell lung cancer patients age of 70 years or older (original) (raw)
Related papers
Cancer, 1992
Etoposide is a schedule-dependent agent with greater activity against small cell lung cancer (SCLC) when a given dose is administered over several days compared with a 1-day administration of the same dose. In an attempt to capitalize on the schedule dependency of etoposide, 22 previously untreated extensive-stage SCLC patients were given cisplatin (100 mg/m2 on day 1) plus 21 days of lowdose, oral etoposide (50 mg/mz/d). Chemotherapy was repeated every 28 days for four cycles. Complete blood counts were monitored weekly, and etoposide was discontinued if either the leukocyte or platelet count dropped below 2000/pl or 75,0OO/p1, respectively. All 22 patients were evaluable for response; 18 had either a complete (9%) or partial response (73%), an overall response rate of 82% (95% confidence interval, 62% to 93%). The median response duration was 7 months, and the median survival was 9.9 months (range, 1 to 17+ months). Sixteen (73%) patients received all planned cycles of etoposide. In Cycle 1 of chemotherapy, the median leukocyte nadir was 2700/pl (range, 100 to 63OO/pl), and median platelet nadir was 180,0OO/pl (range, 51,000 to 397,OOO/pl). Life-threatening leukopenia (< 1OOO/pl) was rare (3 of 74 cycles). There were three treatment-related deaths, only one of which was associated with neutropenia. One patient had mild renal insufficiency that resolved after discontinuation of therapy. Alopecia was observed in all patients, but other nonhematologic toxicities were uncommon. A randomized study is necessary to determine if this schedule of cisplatin and etoposide administration is superior to more standard methods. However, these data do not indicate a major survival benefit will be derived from increasing the duration of etoposide administration when used in combination with cisplatin given every 28 days.
Asian Pacific Journal of Cancer Prevention, 2012
Background: In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. Methods: Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 mg/m 2 on days 1, 8 and cisplatin was added at 75 mg/m 2 on day 1. In the second group (DC), 75 mg/m 2 docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. Result: GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). Conclusion: The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatmetns with regard to sensory neuropathy.
Increasing dose intensity of cisplatin-etoposide in advanced nonsmall cell lung carcinoma
Cancer, 1999
BACKGROUND. The authors designed this randomized, controlled trial to assess whether dose intensification of a cisplatin-etoposide combination (PE), achieved by shortening the interval between chemotherapy cycles, would improve response rate and survival. The maximum tolerated dose of PE was administered in either 3-or 4-week cycles to patients with advanced nonsmall cell lung carcinoma (NSCLC).
Cisplatin-based Chemotherapy in Elderly Patients with Non-small Cell Lung Cancer
International Journal of Gerontology, 2010
Background: The use of cisplatin-based combination chemotherapy in elderly patients with advanced nonsmall cell lung cancer (NSCLC) remains an issue of debate. Methods: We retrospectively reviewed the medical records of all patients ≥ 70 years with stage IIIB and stage IV NSCLC who received chemotherapy between 2000 and 2007 at our hospital. Data on demographic information, chemotherapy regimen and cycle, response, toxicity, and survival time were collected. Survival was analyzed by the Kaplan-Meier method and log-rank test. Results: A total of 102 elderly patients with advanced NSCLC received chemotherapy with a combination of cisplatin plus either vinorelbine or gemcitabine (the cisplatin-based combination group), or single-agent vinorelbine or gemcitabine (the single-agent group). The response rate was 46% in the cisplatin-based combination group, and 25% in the single-agent group (p = 0.03). The median survival was 11.1 months (95% confidence interval, CI, 9.24-12.96] in the cisplatin-based combination group, and 8.9 months (95% CI, 7.68-10.14) in the single-agent group (p = 0.06), and 1-year survival rates were 38.6% and 22.4%, respectively. The median progression-free survival was 7.9 months (95% CI, 5.62-10.18) and 5.8 months (95% CI, 4.78-6.82), respectively (p = 0.03). Grade 3-4 anemia and neutropenia were more frequent in the cisplatin-based combination group. Other toxicities were mild and generally well tolerated in the two groups. Conclusion: Elderly patients ≥ 70 years with advanced NSCLC can tolerate and benefit from cisplatin-based combination chemotherapy. Cisplatin-based chemotherapy may be considered as an option in the treatment of elderly patients with advanced NSCLC.
Cancer Chemotherapy and Pharmacology, 1992
Because of potential synergistic interactions, we added 25 mg/m2 i. v. cisplatin (P) 25 given on days 1 -5 to the combination of 45 mg/m2 i.v. doxorubicin (A) given on day 1,800 mg/m 2 i.v. cyclophosphamide (C) given on day 1, and 50 mg/m 2 i. v. etoposide (E) given on days 1-5. The resulting PACE regimen was given every 21 days for the first three courses and then every 28 days for the next five courses. PACE was used in two trials: the first, for both limited and extensive disease, was conducted at the University of Maryland Cancer Center and North Shore University Hospital; and the second, for extensive disease, was carried out as a Cancer and Leukemia Group B pilot study. Chest irradiation was not used. Prophylactic cranial irradiation at a dose of 3,000 cGy was given to all patients achieving a complete response (CR). A total of 33 subjects were entered in the first study; 8 of the 15 (53%) presenting with limited disease and 7 of the 18 (39%) exhibiting extensive disease achieved a CR. A partial response (PR) was obtained in 27% and 33% of cases, respectively. Of the 34 patients entered in the second study, 25 were eligible; 8 (32%) achieved a CR and 6 (24%) showed a PR. Toxicity was severe in both studies, including >90% severe or life-threatening leukopenia and thrombocytopenia. Serial creatinine-clearance evaluations in the first study indicated progressive deterioration, which required discontinuation of the cisplatin before the planned completion of treatment in most cases. Since the response rate was no higher than the historic data reported for the three-drug ACE combination and because the toxicity was severe, the studies were stopped and patients were followed for survival. After a follow-up period of >6 years, the median survival was 24 months for limited disease, with 33% and 27% of the patients being alive at 3 and 6.5 years, respectively. The median survival for extensive disease was 15 and 11 months in the first and second studies, respectively. Offprint requests to: J. Aisner, UMCC, 22 South Greene St., Baltimore, MD 21201, USA
Oral etoposide preceding cisplatin in advanced non small cell lung cancer (NSCLC). A phase II study
European journal of cancer & clinical oncology, 1988
Forty male patients with locally advanced (LD; 11 patients) and extensive (ED; 29 patients) NSCLC were treated with oral etoposide (240 mg/m2 days 1-3) preceding intravenous cisplatin (100 mg/m2 day 4) at 4 weekly intervals. Eleven patients achieved major response (27.5%; 1 CR, 10 PR). Minor response (MR) occurred in seven patients (17.5%); stable disease (SD) in seven patients (17.5%) and progressive disease (PD) in 15 (37.5%). The median duration of response in major responders was 31 weeks. The median survival time (MST) in all patients was 42 weeks. Patients achieving response, and stable disease lived significantly longer than progressors (P less than 0.0001; 56 vs. 9 weeks respectively). The MST of non-progressors in both LD and ED was significantly increased as compared to progressors. Two patients with poor risk prognostic variables died from myelosuppression-related infection early during the first course of chemotherapy. The remainder of the courses were without severe hem...
Correlation of clinical pharmacokinetic parameters of cisplatin with efficacy and toxicity
Biomedicine & Pharmacotherapy, 1991
Twenty-two pharmacokinetic studies were carried out in 11 patients receiving cisplatin (20 mg/m2 per d) associated with etoposide (50 mg/m' per d), as 5day continuous infusions, every 4 weeks. Blood was withdrawn at 8:30 am from day 1-5. Within 15 min after taking the blood, an aiiquot of plasma 'was filtered for the ultrafilterable platinum (UP) assay. Total platinum (TP) and UP were assayed by flameless atomic absorption. The plasma concentrations and AUCo.Iroh of TP were correlated with those of UP (P < 0.05 to Y c 0.001). TP concentrations increased significantly during the infusion and with each successive course, whereas the increase of plasma concentration of UP during and between courses was not statistically significant. Th,e responders had significantly higher levels of TP (AUC, concentrations) in the first and second courses than the non-responders.
Cancer, 1990
A Phase I1 randomized study testing the combination of cisplatin, etoposide, and ifosfamide (PEI) in non-small cell lung cancer (NSCLC) was performed. The standard combination of cisplatin and etoposide (PE) was used as the control arm. Since January 1987, 78 patients were enrolled and then stratified for previous treatments and performance status (PS). The response rate (RR) of PEI was 26% (95% confidence limits [95 CL], 12% to 40%), with one complete response (CR). The RR of PE was 26% (95 CL, 13% to 39%), with no CR. The median response duration was 5 months (range, 2 to 13 months) for PEI and 4 months (range, 2 to 6 months) for PE. The median survival time was 6 months (range, 1 to 22+ months) for PEI and 7 months (range, 1 to 21f months) for PE. Leukopenia at recycling was similar in both arms (25% for PEI and 29% of PE). The median leukocyte nadir was 2100/pl (range, 430 to 4870/pl) for PEI patients and 3150/pl (range, 500 to 5000/& for PE patients. Three patients had a drug-related death secondary to infections. This Phase I1 randomized study suggested that the combination of cisplatin plus etoposide and ifosfamide produces results similar to those obtainable with cisplatin and etoposide. Cancer 65:2631-2634,1990.
Cancer, 1991
A dose escalation study of daily oral etoposide and cisplatin was carried out on 22 patients with advanced cancer using starting doses of 20 mg/m2/d of etoposide given orally for 21 days and 80 mg/mz of cisplatin given intravenously (IV) on day 1. A total of 40 courses were given. Myelosuppression was the major dose-limiting toxicity, with a maximum tolerated dose of 50 mg/m2/d of oral etoposide for 21 days plus 80 mg/m2 of IV cisplatin on day 1. Doses of 40 mg/m2/d of etoposide for 21 days plus 80 mg/m2 of cisplatin for 1 day in four of eight courses (50%) were associated with Grade 3 or worse leukopenia that occurred between days 18 and 26. However, no Grade 3 or worse thrombocytopenia occurred at this dose level. Nausea and vomiting occurred in most patients at each dose level but were mild and could be controlled by antiemetics. Alopecia also occurred frequently. Significant mucositis (Grade 4) occurred in one patient, but no other toxicities were observed. Four partial responses that lasted from 1.3 to 5 . 8 f months were observed in patients with cervical (one patient), small cell lung (one patient), and squamous cell lung cancer (two patients); one of them had been heavily pretreated with platin analogue-containing regimens. The recommended doses for Phase 11 studies on this schedule are 40 mg/m2/d of oral etoposide for 21 days plus 80 mg/m2 of IV cisplatin on day 1. A combination regimen on this schedule seems particularly effective in patients with etoposide-sensitive malignancies. Cancer 68284488, 1991.