Comparison of outcomes for elderly patients treated with weekly paclitaxel in combination with carboplatin versus the standard 3‐weekly paclitaxel and carboplatin for advanced nonsmall cell lung cancer

BACKGROUND. The purpose of this study was to compare the outcomes between elderly (aged ≥70 years) patients treated with paclitaxel on a weekly basis and with carboplatin (every 4 weeks) versus the standard 3‐weekly regimen of carboplatin and paclitaxel for first‐line therapy of advanced nonsmall cell lung cancer. METHODS. Of the 444 patients enrolled, 136 (31%) were aged ≥70 years. Seventy‐two patients were randomized to the weekly schedule (paclitaxel, 100 mg/m2 weekly for 3 of 4 weeks; carboplatin, area under the curve [AUC] = 6 mg/mL·min on Day 1 every 4 weeks), and 64 patients were randomized to the standard schedule (paclitaxel, 225 mg/m2; carboplatin, AUC = 6 mg/mL·min on Day 1 every 21 days). Patients with stable disease or objective response after 4 cycles of therapy were eligible for maintenance therapy with weekly paclitaxel (70 mg/m2, 3 of 4 weeks). RESULTS. The response rate for elderly patients was 26% on the weekly regimen and 19% on the standard schedule. The median survival duration for the weekly and the standard schedules was 37 weeks and 31 weeks, respectively. The 1‐year survival rates were similar at 31% and 33%. Grade 3 to 4 anemia was more common on the weekly schedule (16% vs 6%), whereas grade 3 neuropathy was less common (5.5% vs 9.5%). Nausea and emesis were also less frequent on the weekly schedule. CONCLUSIONS. Efficacy was similar between the weekly regimen and the standard regimen of carboplatin and paclitaxel for elderly patients with advanced NSCLC and may be advantageous based on its favorable tolerability profile. Cancer 2008. © 2008 American Cancer Society. Efficacy was similar between a weekly regimen and a standard regimen of carboplatin and paclitaxel for elderly patients with advanced NSCLC. Elderly patients on the weekly regimen exhibited better tolerance than those on the standard regimen. Thus, the weekly regimen offers an advantageous tolerability profile to this patient population.