Table 5. Use of AC in elderly patients.
| Study | Number of patients who underwent surgical resection; stage disease | Number of patients received AC | Period of recruitment | AC use in elderly patients | Chemotherapy regimen prescribed | Dose modification or omission | Survival analysis elderly patients |
|---|---|---|---|---|---|---|---|
| Booth et al., 2010, (47) | 3,354; 43% older ≥70 years old; I–IV | 1,224 | Retrospective (2001 → 2006) | 16% of patients >70 years old received AC | Cisplatin or carboplatin-based regimen | – | – |
| Cuffe et al., 2012, (48) | 6,304; 43.8% older ≥70 years old; I–IV | 1,224 | Retrospective (2001 → 2006) | 70–74 years old: 191 patients received AC among 1,317 who underwent lung resection | Cisplatin-based regimen (with vinorelbine or etoposide); carboplatin-based regimen (with vinorelbine or paclitaxel); other | 584 chemotherapy data available: | – |
| 75–79 years old: 81 patients received AC among 980 who underwent lung resection | 584 chemotherapy data available: | Cisplatin changed for carboplatin: 5% among 75–79 years old patients | |||||
| ≥80 years old: 13 patients received AC among 466 patients who underwent lung resection | Cisplatin-based: 71% (70–74 years old), 67% (75–79 years old), 71% (≥80 years old) |
Dose reduction: 30% (70–74 years old), 32% (75–79 years old) | |||||
| Carboplatin-based: 26% (70–74 years old), 33% (75–79 years old), 29% (≥80 years old) |
Dose omission: 21% (70–74 years old), 32% (75–79 years old), 25% (≥80 years old) | ||||||
| Ganti et al.,2015, (49) | 7,593; 38% older ≥70 years old; IB–III | 1,928 | Retrospective (2001 → 2011) | Percentage of older patients (i.e., ≥70 years old) who received AC: approximately one half of younger patients (15.3% vs. 31.6%; P<0.0001) | Cisplatin or carboplatin-based regimen | – | As for younger patients, AC significantly improved OS among patients ≥70 years old [adjusted HR (95% CI): 0.81 (0.71–0.92)] |
| Compared with younger patients, patients ≥70 years old received significantly more frequently carboplatin-based regimen (72% vs. 62.3%; P<0.0001) | |||||||
| Kankesan et al., 2013, (52) | 3,354; 45% older ≥70 years old; I–IV | 1,032 | Retrospective (2004 → 2006) | Patients older than 70 years old significantly less referred to medical oncologist (45% of patients; P<0.001) | – | – | – |
| Patients older than 70 years old significantly less treated with AC (35% of patients older than 70 years old referred to medical oncologist treated with AC; P<0.001) | |||||||
| Rajaram et al., 2016, (28) | 112,049; 20% older ≥75 years old; IB–IIIA | 31,709 | Retrospective (2002 → 2011) | Compared to patients younger than 55 years old, patients older than 56 years old have significantly less likelihood to receive AC [adjusted OR (95% CI); especially among patients >75 years old: 0.15 (0.12–0.18); P<0.001] | – | – | – |
| Berry et al., 2015, (50) | 2,781 patients >65 years old; stage II | 784 | Retrospective (1992 → 2006) | Patients aged 70–74, 75–79, 80–84 and ≥85 years old received significantly less AC | Platinum-based regimen administered to 76% of patients | 61% received four or more cycles (no information about dose reduction) | AC remained an independent prognostic factor associated with survival among all patients aged ≥66 years old (P=0.0002) |
| Wisnivesky et al., 2011, (53) | 3,324 patients >65 years old; IIA–IIIA | 684 | Retrospective (1992 → 2005) | – | – | – | AC associated with improved OS for patients 70–79 years old [adjusted HR (95% CI): 0.82 (0.71–0.94)] |
| No survival benefit for patients older than 80 years old [adjusted HR (95% CI): 1.33 (0.86–2.06)] | |||||||
| Rodriguez et al., 2012, (33) | 99; 30% ≥70 years old; IB, II and higher | 53 | Retrospective (2006 → 2011) | Patients ≥70 years old received significantly less AC compared to youngers; (25% vs. 66.7%; P<0.01) | – | Significantly less cycles of chemotherapy received for patients aged ≥70 years old (median number of cycles received 2 {range, [1–2]} compared to younger (median number of cycles received 4 {range, [2–4]}; P=0.04 | – |
| Batum et al., 2018, (54) | –; IA–IIIB | 91 | Retrospective (2012 → 2016) | – | Platinum-based regimen with vinorelbine, pemetrexed, gemcitabine, etoposide, docetaxel | No significant differences between number of cycles of AC received | No significant differences between younger and older patients in terms of OS (P=0.119) and DFS (P=0.407) |
| >65 years old patients treated with: platinum + vinorelbine (70%); carboplatin-based regimen (5%) | 90% of patients >65 years old completed four cycles of AC | ||||||
| No significant differences in chemotherapy regimen administered between younger and older patients | |||||||
| Zhai et al., 2016, (39) | –; IB–IIIA | 865 | Retrospective (2001 → 2013) | – | Platinum-based regimen with vinorelbine, pemetrexed, gemcitabine, docetaxel, paclitaxel | No significant differences between number of cycles of AC received | No significant differences in DFS between younger and older patients (P=0.328) |
| No significant differences in chemotherapy regimen received between younger (i.e., <65 years old) and older patients (i.e., ≥65 years old) | 79.1% of patients ≥65 years old completed four cycles of AC | ||||||
| No significant differences in mean time to receive AC after surgery between younger and older patients | |||||||
| Park et al., 2013, (55) | –; IB–IIIA | 139 | Retrospective (2008 → 2011) | – | Chemotherapy regimen: cisplatin-vinorelbine or carboplatin-paclitaxel | No significant differences in mean dose intensity and relative dose intensity between younger and older patients for both AC regimen | No significant differences between aged groups (i.e., <65 years old and ≥65 years old) in terms of OS (P=0.4274) and relapse-free survival (P=0.4512) |
| Elderly patients (66 patients ≥65 years old) most frequently treated with carboplatin-paclitaxel (54.5%) and less frequently with cisplatin-vinorelbine (45.5%) although not significant | 92.4% of elderly patients completed 4 cycles of AC | ||||||
| 40.9% of elderly patients has a dose reduction, no significant difference compared to youngers | |||||||
| Lin et al., 2012, (51) | 2,231; 764 patients ≥70 years old; IA–IIIA | 428 | Retrospective (2004 → 2007) | Among patients ≥70 years old with stage II disease: 16% received AC | Platinum-based regimen | – | Among patients >70 years old with stage II and IIIA disease: AC use associated with a significant improvement of OS compared to surgery alone |
| Among patients ≥70 years old with stage IIIA disease: 42% received AC |
AC, adjuvant chemotherapy; OS, overall survival; DFS, disease-free survival.