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Adjuvant Vinorelbine and Cisplatin in Elderly Patients: National Cancer Institute of Canada and Intergroup Study JBR.10

Carmela Pepe, Baktiar Hasan, Timothy L. Winton, Lesley Seymour, Barbara Graham, Robert B. Livingston, David H. Johnson, James R. Rigas, Keyue Ding, Frances A. Shepherd

From the Division of Medical Oncology, Princess Margaret Hospital, University Health Network, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; Southwest Oncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Boston, MA; and Cancer and Leukemia Group B, Chicago, IL

Address reprint requests to Carmela Pepe, MD, FRCPC, Pulmonary Division, Sir Mortimer B. Davis–Jewish General Hospital, 3755 Côte Ste-Catherine Rd, Room G-203, Montréal, Québec, Canada, H3T 1E2; e-mail: carmela.pepe{at}mail.mcgill.ca

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 ( 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.

published online ahead of print at www.jco.org on March 19, 2007.

C.P. and B.H. contributed equally to this work.

Presented at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Supported in part by a grant from GlaxoSmithKline (then Burroughs Wellcome).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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