Abstract | BACKGROUND: : Although platinum-based combinations are considered the best option of care for patients with advanced nonsmall cell lung cancer (NSCLC), single-agent therapy is the preferred treatment for older patients. Since the late 1990s, various combinations of third-generation agents ( gemcitabine [G], vinorelbine, docetaxel, and paclitaxel) have been tested, yielding contradictory results. The authors of this report performed a literature-based meta-analysis to assess the efficacy and tolerability of G-based doublets compared with single-agent chemotherapy for elderly patients with NSCLC. METHODS: : Data from all published, randomized, phase 3 trials that compared a G-based doublet with a third-generation single agent in elderly patients were collected from electronic databases (Medline and the Cochrane Central Register of Controlled Trials), relevant reference lists, and abstract books. Pooled odds ratios ( ORs) were calculated for the 1-year survival rate, the overall response rate (ORR), and grade 3 and 4 toxicities. RESULTS: : Four eligible trials (1436 patients) were selected from 442 studies that initially were identified. A significant difference in ORR favoring G-based doublets over single agents was observed (OR, 0.65; 95% confidence interval [95% CI], 0.51-0.82 [P < .001]), whereas the trend toward an improved 1-year survival rate was not significant (OR, 0.78; 95% CI, 0.57-1.06 [P = .169]). Grade 3 and 4 toxicities did not differ significantly except for thrombocytopenia (OR, 1.76; 95% CI, 1.12-2.76 [P = .014]). CONCLUSIONS: : G-based doublets appeared to be effective and feasible compared with single agents in the treatment of elderly patients with advanced NSCLC who were not suitable for full-dose, platinum-based chemotherapy. Further prospective, elderly specific, phase 3 trials will be necessary. Cancer 2009. (c) 2009 American Cancer Society.
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Authors | Antonio Russo, Sergio Rizzo, Fabio Fulfaro, Vincenzo Adamo, Daniele Santini, Bruno Vincenzi, Nicola Gebbia, Ignazio Carreca |
Journal | Cancer
(Cancer)
Vol. 115
Issue 9
Pg. 1924-31
(May 01 2009)
ISSN: 0008-543X [Print] United States |
PMID | 19235250
(Publication Type: Comparative Study, Journal Article, Meta-Analysis)
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Chemical References |
- Taxoids
- Deoxycytidine
- Vinblastine
- Vinorelbine
- Gemcitabine
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Topics |
- Aged
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects, therapeutic use)
- Carcinoma, Non-Small-Cell Lung
(drug therapy, mortality)
- Clinical Trials, Phase III as Topic
- Deoxycytidine
(administration & dosage, analogs & derivatives)
- Humans
- Lung Neoplasms
(drug therapy, mortality)
- Randomized Controlled Trials as Topic
- Taxoids
(therapeutic use)
- Vinblastine
(analogs & derivatives, therapeutic use)
- Vinorelbine
- Gemcitabine
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