Abstract
A study was conducted to examine the feasibility of cisplatin‐based chemotherapy in elderly patients (75 years old) with advanced non‐small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Thirty‐four patients were enrolled between September 1993 and December 1994. Patients with normal organ function and good performance status (PS) received cisplatin‐based chemotherapy (cisplatin 80 mg/m2 on day 1 and vindesine 3 mg/m2 on days 2 and 8 for NSCLC, or cisplatin 80 mg/ m2 on day 1 and etoposide 100 mg/m2 on days 2 to 4 for SCLC). Ten patients (29%) were eligible for this study, 7 with NSCLC and 3 with SCLC. Reasons for exclusion were ischemic heart disease in 14, poor PS (2) in 11, reduced creatinine clearance (Ccr) in 10, abnormal electrocardiogram without ischemia in 9 and noncompliance with the protocol in 2 patients. Eight patients had two or more reasons. Nine of the 10 eligible patients were able to tolerate 2 or more courses of chemotherapy. All 3 patients with SCLC responded (1 complete response and 2 partial response), but only 1 of the patients with NSCLC achieved partial response. Toxicity was evaluated according to Japan Clinical Oncology Group criteria. All but one patient experienced grade 4 neutropenia, and 6 patients had infectious episodes requiring antibiotics. Grade 3 anemia and thrombocytopenia were observed in 1 and 2 patients, respectively. Non‐hematological toxicities were mild. Only 10 of 34 patients (29%) satisfied our eligibility criteria and they experienced severe myelotoxicity. We conclude that chemotherapy should be given carefully to elderly patients even if they appear to have normal organ function.
Keywords: Elderly patient, Cisplatin, Lung cancer
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REFERENCES
- 1. ) Fukuoka , M. , Furuse , K. , Saijo , N. , Nishiwaki , Y. , Ikegami , H. , Tamura , T. , Shimoyama , M. and Sueraasu , K.Randomized trials of cyclophosphamide, doxorubicin, and vincristine versus cisplatin and etoposide versus alternation of these regimens in small—cell lung cancer . J. Natl. Cancer Inst. , 83 , 855 – 861 ( 1991. ). [DOI] [PubMed] [Google Scholar]
- 2. ) Shinkai , T. , Eguchi , K. , Sasaki , Y. , Tamura , T. , Ohe , Y. , Kojima , A. , Oshita , F. and Saijo , N.A randomised clinical trial of vindesine plus cisplatin and mitomycin plus vindesine and cisplatin in advanced non‐small cell lung cancer . Eur. J. Cancer , 27 , 571 – 575 ( 1991. ). [DOI] [PubMed] [Google Scholar]
- 3. ) Egorin , M. J.Cancer pharmacology in the elderly . Semin. Oncol. , 20 , 43 – 49 ( 1993. ). [PubMed] [Google Scholar]
- 4. ) Begg , C. B. and Carbone , P. P.Clinical trials and drug toxicity in the elderly. The experience of the Eastern Cooperative Oncology Group . Cancer , 52 , 1986 – 1992 ( 1983. ). [DOI] [PubMed] [Google Scholar]
- 5. ) Poplin , E. , Thompson , B. , Whitacre , M. and Aisner , J.Small cell carcinoma of the lung: influence of age on treatment on outcome . Cancer Treat. Rep. , 71 , 291 – 296 ( 1987. ). [PubMed] [Google Scholar]
- 6. ) Oshita , F. , Shinkai , T. , Miya , T. , Kojima , A. , Ohe , Y. , Tamura , T. , Sasaki , Y. , Eguchi , K. and Saijo , N.The relation between myelotoxicity and performance status or aging in chemotherapy of non‐small cell lung cancer . Jpn. J. Thorac. Dis. , 29 , 231 – 238 ( 1991. ) ( in Japanese ). [PubMed] [Google Scholar]
- 7. ) Hrushesky , W. J. M. , Shimp , W. and Kennedy , B. J.Lack of age—dependent cisplatin toxicity . Am. J. Med. , 76 , 579 – 584 ( 1984. ). [DOI] [PubMed] [Google Scholar]
- 8. ) Tobinai , K. , Kohno , A. , Shimada , Y. , Watanabe , T. , Tamura , T. , Takeyama , K. , Narabayashi , M. , Fukutomi , T. , Kondo , H. , Shimoyama , M. , Suemasu , K.and Members of the Clinical Trial Review Committee of the Japan Clinical Oncology Group. Toxicity grading criteria of the Japan Clinical Oncology Group . Jpn. J. Clin. Oncol. , 23 , 250 – 257 ( 1993. ). [PubMed] [Google Scholar]
- 9. ) Grogan , L. , Corbally , N. , Dervan , P. A. , Byrne , A. and Carney , D. N.Comparable prognostic factors and survival in elderly patients with aggressive non—Hodgkin's lymphoma treated with standard‐dose adriamycm‐based regimens . Ann. Oncol. , 5 ( Suppl. 2 ), 47 – 51 ( 1994. ). [DOI] [PubMed] [Google Scholar]
- 10. ) Oshita , F. , Tamura , T. , Okamoto , H. , Miya , T. , Kojima , A. , Ohe , Y. , Sasaki , Y. , Eguchi , K. , Shinkai , T. and Saijo , N.The frequency and management of infectious episodes and sepsis in small cell lung cancer patients receiving intensive chemotherapy with granulocyte‐colony stimulating factor . Jpn. J. Clin. Oncol. , 21 , 353 – 359 ( 1991. ). [PubMed] [Google Scholar]
- 11. ) Yamamoto , N. , Tamura , T. , Ando , M. , Maeda , M. , Shinkai , T. , Eguchi , K. , Ohe , Y. , Oshita , F. , Shiraishi , J. , Katsumata , N. and Saijo , N.The influence of aging on cisplatin pharmacokinetics in lung cancer patients with normal organ function . Cancer Chemother. Pharmacol , 36 , 102 – 106 ( 1995. ). [DOI] [PubMed] [Google Scholar]
- 12. ) de Jongh , C. A. , Wade , J. C. , Finley , R. S. , Joshi , J. H. , Aisner , J. , Wiernik , P. H. and Schimpfr , S. C.Trimetho‐prim/sulfamethoxasole versus placebo: a double‐blind comparison of infection prophylaxis in patients with small cell carcinoma of the lung . J. Clin. Oncol. , 1 , 302 – 307 ( 1983. ). [DOI] [PubMed] [Google Scholar]