Ito Masaru, Horita Nobuyuki, Nagashima Akimichi, Kaneko Takeshi
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Asia Pac J Clin Oncol. 2019 Apr;15(2):e3-e10. doi: 10.1111/ajco.12837. Epub 2018 Jan 8.
In some developed countries, a proportion of nonsquamous non-small cell lung cancer (NSq NSCLC) patients are aged over 70 years when they are diagnosed. However, evidence of lung cancer chemotherapy usually comes from randomized controlled trials that only recruit younger patients with good performance status. In daily practice, less-toxic carboplatin + pemetrexed regimen is often used for elderly patients, although this regimen is not sufficiently supported by rigid evidence for elderly cases.
The protocol was registered on PROSPERO website (42017058508). Any phase trial that evaluated the efficacy and safety of carboplatin + pemetrexed in the elderly (aged 70 or higher) was included. Binary data were meta-analyzed with the random-model generic inverse variance method. Median survival duration was pooled after logarithmic transformation.
Eight studies consisting of 285 patients were included among 882 articles that met the preliminary criteria. The pooled median overall survival and progression-free survivals were 14.9 months (95% confidence interval [95% CI], 12.0-18.4) and 5.4 months (95% CI, 4.5-6.4), respectively. The pooled response rate was 34.0% (95% CI, 27.5-40.5). Hematological adverse events such as neutropenia (≥grade 3; 48.3%; 95% CI, 40.1-56.6), thrombocytopenia (≥grade 3; 27.9%; 95% CI, 15.8-39.9), and anemia (≥grade 3; 17.1%; 95% CI, 8.3-25.8) were frequently observed. However, febrile neutropenia (6.8%; 95% CI, 0.2-13.3), nausea (≥grade 3; 0%; 95% CI, 0.0-4.4%) and treatment-related death (0.6%; 95% CI, 0-5.4%) were rare.
Carboplatin + pemetrexed can be a good option for the treatment of the elderly with NSq NSCLC.
在一些发达国家，部分非鳞状非小细胞肺癌（NSq NSCLC）患者确诊时年龄超过70岁。然而，肺癌化疗的证据通常来自随机对照试验，这些试验仅招募身体状况良好的年轻患者。在日常实践中，毒性较小的卡铂+培美曲塞方案常被用于老年患者，尽管该方案在老年病例方面缺乏确凿证据支持。
该方案已在PROSPERO网站（42017058508）注册。纳入任何评估卡铂+培美曲塞在老年（70岁及以上）患者中疗效和安全性的各期试验。二元数据采用随机模型通用逆方差法进行荟萃分析。对数转换后汇总中位生存时间。
在符合初步标准的882篇文章中，纳入了8项研究，共285例患者。汇总的中位总生存期和无进展生存期分别为14.9个月（95%置信区间[95%CI]，12.0 - 18.4）和5.4个月（95%CI，4.5 - 6.4）。汇总缓解率为34.0%（95%CI，27.5 - 40.5）。经常观察到血液学不良事件，如中性粒细胞减少（≥3级；48.3%；95%CI，40.1 - 56.6）、血小板减少（≥3级；27.9%；95%CI，15.8 - 39.9）和贫血（≥3级；17.1%；95%CI，8.3 - 25.8）。然而，发热性中性粒细胞减少（占6.8%；95%CI，0.2 - 13.3）、恶心（≥3级；占0%；95%CI，0.0 - 4.4%）和治疗相关死亡（占0.6%；95%CI，0 - 5.4%）较为罕见。
卡铂+培美曲塞可作为老年NSq NSCLC患者治疗的一个良好选择。
