Author of

• 12592

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  P3.10 - Poster Session 3 - Chemotherapy (ID 210)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12634

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    P3.10-042 - Cisplatin vs. Carboplatin-based Chemoradiotherapy in Elderly Patients with Unresected Stage III Non-small Cell Lung Cancer (ID 2421)

    09:30 - 09:30  |  Author(s): J.P. Wisnivesky
    • Abstract

    Background
    Combined chemoradiotherapy (CRT) is the standard therapy for unresectable stage III non-small cell lung cancer (NSCLC). The most commonly used (~80%) chemotherapy regimens are platinum (cisplatin or carboplatin)-based. While carboplatin has been favored in older patients with comorbidities, there is very limited data regarding tolerability of these regimens in the elderly. In this study, we used population-based data to compare survival and toxicity of elderly stage III NSCLC patients treated with carboplatin vs. cisplatin-based chemotherapy in combination with radiotherapy.

    Methods
    Using the Surveillance, Epidemiology and End Results (SEER) database linked to Medicare records we identified 2,057 patients >65 years of age with histologically confirmed, unresected stage III NSCLC that received concurrent chemoradiotherapy between 2002 and 2009. We limited the cohort to patients treated with platinum-based regimens. We used logistic regression to fit a propensity score model predicting use of cisplatin-based therapy. Overall and lung-cancer specific survival of patients treated with cisplatin vs. carboplatin was compared after adjusting for propensity scores. We identified severe treatment-related toxicity requiring hospitalization and compared these rates among patients treated with cisplatin vs. carboplatin after controlling for propensity scores.

    Results
    Overall, 347 (16%) patients received cisplatin, most commonly (70%) in combination with taxanes. Patients treated with cisplatin were younger (p<0.001), more likely to be married (p=0.01), and had lower comorbidity burden (p=0.008). There were no significant differences in other sociodemographic characteristics, tumor location, and T or N status among patients treated with cisplatin vs. carboplatin (p >0.05 for all comparisons). Cox models adjusting for propensity scores showed that overall (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.86-1.11) and lung cancer-specific (HR: 1.01, 95% CI: 0.86-1.18) survival were similar for cisplatin compared with carboplatin-treated stage III patients. Adjusted analyses also showed that cisplatin-treated patients had increased risk of severe neutropenia (odds ratio [OR]: 2.70, 95% CI: 1.61-4.51), anemia (OR: 1.32, 95% CI: 1.01-1.73), and thrombocytopenia (OR: 1.62, 95% CI: 1.01-2.62). Rates of infection (OR: 1.10, 95% CI: 0.76-1.58), fever (OR: 1.07, 95% CI: 0.43-2.64), dehydration (OR: 1.11, 95% CI: 0.84-1.49), emesis/diarrhea (OR: 1.77, 95% CI: 0.98-3.20), and renal failure (OR: 1.58, 95% CI: 0.91-2.76) were not significantly different among groups.

    Conclusion
    Carboplatin, compared to cisplatin-based, chemotherapy is associated with similar long-term survival but lower rates of severe toxicity when used in combination with radiotherapy to treat elderly patients with stage III NSCLC. These data suggest that carboplatin may be the preferred therapy for elderly patients with locoregional NSCLC.