Should Cisplatin Accompany First-Line NSCLC Treatment in Elderly Patients?
Posted: Wednesday, September 12, 2018
The addition of cisplatin to first-line treatment of advanced EGFR-negative non–small cell lung cancer (NSCLC) does not seem to confer an overall survival benefit. This finding was based on a combined analysis of two parallel phase III trials and was reported by Cesare Gridelli, MD, of the S.G. Moscati Hospital, Avellino, Italy, and colleagues in the Journal of Clinical Oncology.
In this joint analysis, 531 patients older than 70 years of age with any (MILES-3 trial) or nonsquamous (MILES-4 trial) NSCLC were randomized to receive gemcitabine or pemetrexed with (n = 263) or without (n = 268) cisplatin. Median overall survival was 9.6 months in the group receiving cisplatin, compared with 7.5 months in the group not receiving cisplatin (P = .14), which the investigators considered “not significantly prolonged.” However, the addition of cisplatin appeared to yield better progression-free survival and objective response rates (15.5% vs. 8.5%). Quality-of-life scores did not differ between the two groups (P = .80).
As for adverse events, patients receiving cisplatin experienced increased toxicity compared with those receiving first-line agents alone. Hematologic toxicity, fatigue, and anorexia were among the most frequent severe adverse effects associated with the addition of cisplatin.
Based on the toxicity profile of cisplatin, the authors noted that this combination may even preclude “the use of more recent and innovative treatment options” in this patient population. “Standard treatment should remain single-agent chemotherapy whereas carboplatin-based combinations might be considered as an alternative in selected cases with caution regarding potential toxicity,” concluded Dr. Gridelli and colleagues.