Adjuvant vinorelbine and cisplatin in elderly patients

National Cancer Institute of Canada and intergroup study JBR. 10

Carmela Pepe, Baktiar Hasan, Timothy L. Winton, Lesley Seymour, Barbara Graham, Robert B Livingston, David H. Johnson, James R. Rigas, Keyue Ding, Frances A. Shepherd

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Purpose: Recent trials have shown significant survival benefit from adjuvant chemotherapy for non-small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10. Patients and Methods: Pretreatment characteristics and survival were compared for 327 young (≤ 65 years) and 155 elderly (> 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young). Results: Baseline demographics by age were similar with the exception of histology (adenocarcinoma: 58% young, 43% elderly; squamous: 32% young, 49% elderly; P = .001) and performance status (PS; PS 0: 53% young, 41 % elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95% CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9%) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1%) of 71 in the elderly (P = .13). Conclusion: Despite elderly patients' receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.

Original languageEnglish (US)
Pages (from-to)1553-1561
Number of pages9
JournalJournal of Clinical Oncology
Volume25
Issue number12
DOIs
StatePublished - Apr 20 2007
Externally publishedYes

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National Cancer Institute (U.S.)
Cisplatin
Canada
Adjuvant Chemotherapy
Survival
vinorelbine
Drug Therapy
Platinum
Non-Small Cell Lung Carcinoma
Histology
Adenocarcinoma
Hospitalization
Therapeutics
Retrospective Studies
Age Groups

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Adjuvant vinorelbine and cisplatin in elderly patients : National Cancer Institute of Canada and intergroup study JBR. 10. / Pepe, Carmela; Hasan, Baktiar; Winton, Timothy L.; Seymour, Lesley; Graham, Barbara; Livingston, Robert B; Johnson, David H.; Rigas, James R.; Ding, Keyue; Shepherd, Frances A.

In: Journal of Clinical Oncology, Vol. 25, No. 12, 20.04.2007, p. 1553-1561.

Research output: Contribution to journalArticle

Pepe, C, Hasan, B, Winton, TL, Seymour, L, Graham, B, Livingston, RB, Johnson, DH, Rigas, JR, Ding, K & Shepherd, FA 2007, 'Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and intergroup study JBR. 10', Journal of Clinical Oncology, vol. 25, no. 12, pp. 1553-1561. https://doi.org/10.1200/JCO.2006.09.5570
Pepe, Carmela ; Hasan, Baktiar ; Winton, Timothy L. ; Seymour, Lesley ; Graham, Barbara ; Livingston, Robert B ; Johnson, David H. ; Rigas, James R. ; Ding, Keyue ; Shepherd, Frances A. / Adjuvant vinorelbine and cisplatin in elderly patients : National Cancer Institute of Canada and intergroup study JBR. 10. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 12. pp. 1553-1561.
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title = "Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and intergroup study JBR. 10",
abstract = "Purpose: Recent trials have shown significant survival benefit from adjuvant chemotherapy for non-small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10. Patients and Methods: Pretreatment characteristics and survival were compared for 327 young (≤ 65 years) and 155 elderly (> 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young). Results: Baseline demographics by age were similar with the exception of histology (adenocarcinoma: 58{\%} young, 43{\%} elderly; squamous: 32{\%} young, 49{\%} elderly; P = .001) and performance status (PS; PS 0: 53{\%} young, 41 {\%} elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95{\%} CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9{\%}) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1{\%}) of 71 in the elderly (P = .13). Conclusion: Despite elderly patients' receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.",
author = "Carmela Pepe and Baktiar Hasan and Winton, {Timothy L.} and Lesley Seymour and Barbara Graham and Livingston, {Robert B} and Johnson, {David H.} and Rigas, {James R.} and Keyue Ding and Shepherd, {Frances A.}",
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T1 - Adjuvant vinorelbine and cisplatin in elderly patients

T2 - National Cancer Institute of Canada and intergroup study JBR. 10

AU - Pepe, Carmela

AU - Hasan, Baktiar

AU - Winton, Timothy L.

AU - Seymour, Lesley

AU - Graham, Barbara

AU - Livingston, Robert B

AU - Johnson, David H.

AU - Rigas, James R.

AU - Ding, Keyue

AU - Shepherd, Frances A.

PY - 2007/4/20

Y1 - 2007/4/20

N2 - Purpose: Recent trials have shown significant survival benefit from adjuvant chemotherapy for non-small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10. Patients and Methods: Pretreatment characteristics and survival were compared for 327 young (≤ 65 years) and 155 elderly (> 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young). Results: Baseline demographics by age were similar with the exception of histology (adenocarcinoma: 58% young, 43% elderly; squamous: 32% young, 49% elderly; P = .001) and performance status (PS; PS 0: 53% young, 41 % elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95% CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9%) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1%) of 71 in the elderly (P = .13). Conclusion: Despite elderly patients' receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.

AB - Purpose: Recent trials have shown significant survival benefit from adjuvant chemotherapy for non-small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10. Patients and Methods: Pretreatment characteristics and survival were compared for 327 young (≤ 65 years) and 155 elderly (> 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young). Results: Baseline demographics by age were similar with the exception of histology (adenocarcinoma: 58% young, 43% elderly; squamous: 32% young, 49% elderly; P = .001) and performance status (PS; PS 0: 53% young, 41 % elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95% CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9%) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1%) of 71 in the elderly (P = .13). Conclusion: Despite elderly patients' receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.

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