Sequential versus concurrent paclitaxel and carboplatin for the treatment of advanced non-small cell lung cancer in elderly patients and patients with poor performance status: results of two Phase II, multicenter trials

The primary objective of these trials was to determine the 1-year survival of advanced non-small cell lung cancer (ANSCLC) patients (≥70 years with PS 0-2 or ≥18 years with PS 2) receiving sequential paclitaxel and carboplatin (P→C) or concurrent P+C. The secondary objectives were assessment of toxicities and quality of life. A total of 121 patients with NSCLC were treated. P→C patients received paclitaxel (80 mg/m2) weekly × 3, followed by 1 week of rest; these 4-week cycles were repeated until relapse. At relapse, patients received carboplatin (AUC = 5, IV) on Day 1 of each 3-week cycle until evidence of further progression or lack of improvement. P+C patients received paclitaxel (80 mg/m2) and carboplatin (AUC = 2), weekly × 3, followed by 1 week of rest, until relapse. Patients in both studies were premedicated prior to paclitaxel administration. Sequential P→C resulted in a median survival of 8.2 months (range: <1-18.8) and P+C patients had a median survival of 9.2 months (range: <1-22.0). In both groups (P→C and P+C), the 1-year survival was 31%. For patients treated sequentially, treatment-related AEs (TRAE, ≥Grade 3) included fatigue (7%), neuropathy (5%), and leukopenia and diarrhea (3%, each). Grade 4 AEs were limited to neutropenia, febrile neutropenia, and sepsis (1 episode each). For patients receiving concurrent P+C, TRAE included neutropenia and leukopenia (15%, each) and shortness of breath and bilateral bone pain (10%, each). Leukopenia (n = 2) and neutropenia (n = 1) were the only Grade 4 events reported. The analysis of quality of life (QOL) questionnaires indicated that there were no obvious differences between treatment groups during the study. These drugs and treatment schema were well-tolerated when administered in the community setting and resulted in survival rates that were similar to what is reported in the literature with combination therapy administered to “high risk” patients. Finding the optimal chemotherapy regimen, that can be tolerated, remains a challenge in elderly patients.