Sunday, August 14, 2011

Elderly lung cancer patients benefit more of combination chemotherapy than monotherapy


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Give older lung cancer patients with platinum-based doublet chemotherapy median overall survival compared to monotherapy significantly, despite the increased toxic effects prolongs-need treatment for people with a monotherapy to be reviewed, French researchers wrote in The Lancet.

Cancer kills more men worldwide than any other cancer, while among women in America is the leading cause of cancer since 1987. As people live longer and cancer risk rises with age, there is a significant increase in lung cancer rates among older persons. The average age at which lung cancer being diagnosed today in industrialised countries is between 63 and 70 years.

Many older patients may not be receiving the best treatment because doctors, patients and their families wonder about the toxic effects of some medications have.

Current guidelines recommend monotherapy for patients with NSCLC in advance (non-small cell lung cancer) age more than 70 years and platinum-based doublet chemotherapy for fit younger individuals.

Professor Elisabeth Quoix, Department of the diseases of the breast, Hopitaux Universitaires de Strasbourg and Université de Strasbourg, France and team compared carboplatin and paclitaxel doublet chemotherapy with monotherapy in older people with advanced NSCLC.

451 participants were enrolled in this phase III randomized trial. 226 of them received monotherapy while the other 225 administered doublet chemotherapy (combination therapy). The median follow-up was 30 months, and the average age of patients was 77 years.

The researchers found that: median overall survival in the doublet chemotherapy group was 10.3 monthsMedian total survival in the monotherapy group was 6.2 months1 year survive in the Group doublet was 45% 1-year survival in the monotherapy group 25% 48% of the doublet in the Group of white blood cell therapy had exhausted count12% of the people in the Group monotherapy depleted white blood cell countFeelings of weakness affected were 10% of those in the doublet group6% of the monotherapy Group had feelings of weaknessEven, although the authors recognize that preliminary tests on older people with advanced NSCLC focused concluded that monotherapy was the best treatment, they concluded:

"Most post-hoc subgroup analysis of elderly patients enrolled in clinical trials with no limit of age, however, suggested that fit elderly patients can similar benefits to their younger counterparts of platinum-based doublet chemotherapy. Our study of carboplatin and paclitaxel doublet chemotherapy versus gemcitabine or vinorelbine monotherapy showed a survival advantage with the doublet chemotherapy. "We believe that current treatment paradigm for older patients with advanced non small cell lung cancer should be reconsidered."
Linked comment in the same journalDr Karen L Reckamp, city of hope Comprehensive Cancer Center, Duarte, CA, USA, stated:

"Elderly patients dominate the lung cancer population, but still under-represented in clinical trials. Additional studies are needed that adequate numbers of older adults enroll, and includes a comprehensive geriatric assessment in order to have the knowledge required to properly assess the risk-benefit ratio in treatment decisions, so that a personal approach can be taken. "


Written by Christian Nordqvist
Copyright: Medical News today
Not to be reproduced without the permission of medical news today

Article reference:
"Carboplatin and paclitaxel weekly doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small cell lung cancer: IFCT-0501 randomized, phase 3 trial"
Prof Elisabeth Quoix M, Prof Gérard Zalcman MD, Jean-Philippe Oster MD, Prof Virginie Westeel MD, Eric Pichon MD, Armelle Lavolé MD, Jérôme Dauba MD, Didier Debieuvre MD, Pierre-Jean Souquet MD, Laurence Bigay-Game MD, Eric Dansin MD, Michel Poudenx MD, Olivier Molinier imposes MD, Fabien Vaylet MD, Prof Denis Moro-Sibilot MD, Dominique Herman MD, Jaafar Bennouna MD, Prof Jean along MD, Alain Ducoloné MDMarie-Paule Lebitasy MD, Laurence Baudrin MSc, Silvy Laporte PhD, Bernard Milleron MD
The Lancet, early Online publication, 9 August 2011. DOI: 10.1016/S0140-6736 (11) 60780-0
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