MIAMI BEACHChemotherapy doublets outperform single-agent chemotherapy in advanced non-small-cell lung cancer (NSCLC), producing higher response rates and a modest gain in overall survival, according to results of a study from the Cancer and Leukemia Group B (CALGB), presented at the 38th Annual Meeting of the American Society of Clinical Oncology (ASCO).
"We believe combination chemotherapy or a chemotherapy doublet should be the standard of care for patients with advanced non-small-cell lung cancer," stated Rogerio C. Lilenbaum, MD, director of the Thoracic Oncology Program, Mount Sinai Comprehensive Cancer Center in Miami Beach (ASCO abstract 2).
Although "combination chemotherapy is associated with greater toxicity, mainly hematologic, the clinical implications of these toxicities were minor," Dr. Lilenbaum noted. Quality-of-life measurements did not differ between those patients receiving combination or single-agent chemotherapy. In addition, subset analysis revealed that elderly patients can be treated safely with combination chemotherapy.
"This study and others confirm that elderly patients should not only be offered treatment but offered the same treatment as others," commented Paul A. Bunn, Jr, MD, director of the University of Colorado Cancer Center in Denver and President-Elect of ASCO.
‘Is It Worth It?’
A systematic review of the literature found 25 trials conducted between 1974 and 1996 that compared single-agent to combination therapy in advanced NSCLC. The cumulative results showed a "twofold increase in response rate" for the combination chemotherapy, but it was "associated with a threefold increase in serious adverse effects," Dr. Lilenbaum reported. "We wanted to answer in a scientific manner a question that physicians and patients ask themselves all the time: ‘Is combination chemotherapy worth it?’"
The phase III trial initially included 584 patients with stage IIIB/IV NSCLC, although 23 patients (4%) were ineligible or never received treatment and were excluded from analysis. The median age was 63.5 years, and 26% of patients were over 70. Most were male (399). Eighteen percent had performance status (PS) 2. Quality of life was assessed at baseline and at 2, 6, 9, and 12 months.