Adverse Events Among the Elderly Receiving Chemotherapy for Advanced Non-Small-Cell Lung Cancer

Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA. .
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2010; 28(4):620-7. DOI: 10.1200/JCO.2009.23.8485
Source: PubMed


To describe chemotherapy use and adverse events (AEs) for advanced-stage, non-small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age.
We interviewed patients with newly diagnosed, stages IIIB and IV NSCLC in the population-based cohort studied by the Cancer Care Outcomes Research and Surveillance Consortium, and we abstracted the patient medical records. AEs were medical events occurring during chemotherapy. Using logistic regression, we assessed the association between age and chemotherapy; with Poisson regression, we estimated event rate ratios and adjusted the analysis for age, sex, ethnicity, radiation therapy, stage, histology, and presence and grade of 27 comorbidities.
Of 1,371 patients, 58% (95% CI, 55% to 61%) received chemotherapy and 35% (95% CI, 32% to 38%) had AEs. After adjustment, 72% (95% CI, 65% to 79%) of those younger than 55 years and 47% (95% CI, 42% to 52%) of those age 75 years and older received chemotherapy. Platinum-based therapies were less common in the older-age groups. Pretreatment medical event rates were 18.6% for patients younger than 55 years and were only 9.2% for those age 75 years and older (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91). In contrast, older adults were more likely to have AEs during chemotherapy. The adjusted rate ratios compared with age younger than 55 years were 1.70 for 65- to 74-year-olds (95% CI, 1.19 to 2.43) and 1.34 for those age 75 years and older (95% CI, 0.90 to 2.00).
Older patients who received chemotherapy had fewer pretherapy events than younger patients and were less likely to receive platinum-based regimens. Nevertheless, older patients had more adverse events during chemotherapy, independent of comorbidity. Potential implicit trade-offs between symptom management and treatment toxicity should be made explicit and additionally studied.

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    • "Adverse events (AEs) during the follow-up periods of all of the included studies were determined. AEs [21], [22] could be characterized as fatal, life threatening, required or prolonged existing hospitalization, or persistent or significant disability or indisposition and were graded in accordance with the criteria provided by the National Cancer Institute Common Toxicity [23]. "
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    ABSTRACT: Background: Lung cancer, particularly non-small-cell lung cancer (NSCLC) is the leading cause of cancer mortality. Chemotherapy combined dendritic cells co-cultured with cytokine-induced killer cells (DC-CIK) immunotherapy has been applied in advanced NSCLC patients' treatment, but couldn't provide consistent beneficial results. Therefore, it is necessary to evaluate the efficiency and safety of combination therapy to promote the application. Methods: A literature search for randomized controlled trials of NSCLC was conducted in PubMed database. Before meta-analysis was performed, studies were evaluated heterogeneity. Pooled risk ratios (RRs) were estimated and 95% confidence intervals (CIs) were calculated using a fixed-effect model. Sensitivity analysis was also performed. Results: Six eligible trials were enrolled. Efficiency and safety of chemotherapy followed by DC-CIK immunotherapy (experimental group) and chemotherapy alone (control group) were compared. 1-year overall survival (OS) (P = 0.02) and progression free survival (PFS) (P = 0.005) in the experimental group were significantly increased compared with the control. Disease control rate (DCR) (P = 0.006) rose significantly in experimental group. However, no significant differences between the two groups were observed in 2-year OS (P = 0.21), 2-year PFS (P = 0.10), overall response rate (ORR) (P = 0.76) and partial response (PR) (P = 0.22). Temporary fever, anemia, leukopenia and nausea were the four major adverse events (AEs) treated by chemotherapy. The incidence of anemia, leukopenia and nausea in the experimental group was obviously lower than the control group. Temporary fever rate was higher in experimental group than that in the control, but could be alleviated by taking sufficient rest. Conclusions: Chemotherapy combined with DC-CIK immunotherapy showed superiority in DCR, 1-year OS and PFS, and no more AEs appeared, however, there was no significant improvement in ORR, PR, 2-year OS and PFS. As a whole, the combination therapy is safer but modest in efficacy for advanced NSCLC patients.
    PLoS ONE 09/2014; 9(9):e108958. DOI:10.1371/journal.pone.0108958 · 3.23 Impact Factor
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    • "Elderly patient who received chemotherapy had significantly lower baseline (i.e., pretreatment) medical event rates, which reflected the selection of the fittest elders for treatment. Despite this selection, significantly higher adverse event rates were seen during the chemotherapy among the oldest age group compared to the youngest age group, and these rates reached 42.4% (95% CI, 36.1% to 48.7%) in patients age 65 to 74 years (RR, 1.70; 95% CI, 1.19 to 2.43) before dropping slightly to 36% (95% CI, 28.7% to 43.3%) in patients age 75 years and older (RR, 1.34; 95% CI, 0.90 to 2.00) [41]. These findings are consistent with previous studies that showed that the elderly were much more likely to not receive therapy and that, when treated, the elderly were much more likely to receive less aggressive therapy [42]-[45]. "
    Journal of Cancer Therapy 01/2014; 05(03):281-296. DOI:10.4236/jct.2014.53035
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    • "Thus, it cannot be stated in general that treatment toxicity is higher in elderly patients; this may depend on the type of treatment used. A recent retrospective study by Chrischilles et al. evaluated chemotherapy use and adverse events during treatment of advanced NSCLC in routine clinical practice and concluded that toxicity was increased in elderly patients, but his study mainly looked at first-line treatment with platinum-based combinations [32]. One additional result of this US study was that physicians used carboplatin-based combinations more frequently than cisplatin-based combinations (65.3% vs. 10.4%). "
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    BMC Cancer 01/2012; 12:14. DOI:10.1186/1471-2407-12-14 · 3.36 Impact Factor
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