老年患者辅助使用长春瑞滨和顺铂：加拿大国家癌症研究所及国际协作组研究JBR.10

Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10.

作者信息

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

机构信息

Division of Medical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.

出版信息

J Clin Oncol. 2007 Apr 20;25(12):1553-61. doi: 10.1200/JCO.2006.09.5570.

DOI:10.1200/JCO.2006.09.5570

PMID:17442999

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 (< or = 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.

摘要

目的

近期试验表明，辅助化疗可使非小细胞肺癌（NSCLC）患者的生存率显著提高。老年患者是否能耐受铂类辅助化疗并获得相同的生存优势尚不清楚。这项回顾性研究评估了年龄对加拿大国家癌症研究所（NCIC）临床试验组JBR.10研究中患者生存率、辅助化疗实施情况及毒性的影响。

患者与方法

比较了327名年轻（≤65岁）患者和155名老年（>65岁）患者的预处理特征及生存率。对213名接受治疗的患者（63名老年患者，150名年轻患者）的化疗实施情况及毒性进行了比较。

结果

除组织学类型（腺癌：年轻患者占58%，老年患者占43%；鳞癌：年轻患者占32%，老年患者占49%；P = 0.001）和体能状态（PS；PS 0：年轻患者占53%，老年患者占41%；P = 0.01）外，各年龄组的基线人口统计学特征相似。化疗显著延长了老年患者的总生存期（风险比，0.61；95%可信区间，0.38至0.98；P = 0.04）。这一获益与JBR.10研究中所有患者的情况相似。长春瑞滨和顺铂的平均剂量强度在年轻患者中分别为13.2和18.0 mg/m²/周，在老年患者中分别为9.9和14.1 mg/m²/周（长春瑞滨，P = 0.0004；顺铂，P = 0.001）。老年患者接受的长春瑞滨和顺铂剂量显著较少（长春瑞滨，P = 0.014；顺铂，P = 0.006）。完成治疗的老年患者较少，拒绝治疗的更多（P = 0.03）。各年龄组在毒性、住院情况或治疗相关死亡方面无显著差异。年轻患者中126例死亡中有15例（11.9%）死于非恶性原因，老年患者中71例死亡中有15例（21.1%）（P = 0.13）。