Etoposide phosphate with carboplatin in the treatment of elderly patients with small-cell lung cancer: A phase II study

Background:Although the average age of lung cancer patients isincreasing, many elderly patients remain undertreated, mainly because of thefear of higher treatment toxicity in this category of patients. We conducteda study to evaluate the efficacy and tolerability of a combination therapywith carboplatin (C) and etoposide phosphate (EP) in elderly patients withSmall-Cell Lung Cancer (SCLC).Patients and methods:Previously untreated patients older than 70years with stage IIIB/IV SCLC received a combination of EP (100mg/m² D1, D2, D3) and C (D1, dose calculated according to theCalvert formula). Response rate, survival and toxicity were assessed.Results:Thirty-eight patients (mean age 76 years, range70–88 years) received a total of 162 cycles. Eighteen patients(47%) received the six scheduled cycles. Thirty patients were evaluablefor efficacy (2 CR and 20 PR). The median survival was 237 days and theone-year probability of survival was 26%. The most common adverseeffect was transient grade 3 or 4 neutropenia, observed during 57% ofevaluable cycles, while five episodes of febrile neutropenia also occurred,with one fatal (bactaeriemia). It is noteworthy that no renal or livertoxicity was observed, and no mucitis was noted. Unfortunately, a relativelyhigh proportion of patients died shortly after the start of the study.Although most deaths seemed unrelated to the treatment, the possibility of itsexacerbatory effect on comorbidities, especially cardiovascular, cannot beexcluded.Conclusion:The two-drug regimen of carboplatin and etoposidephosphate is feasible in most elderly patients with an acceptable toxicity,and the overall results suggest that patients even older than 70 years maybenefit from full treatment. Therefore, consideration should be given tooffering active treatment to most patients with SCLC, regardless of age butwith special attention paid to comorbidities.