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Pooled Analysis of the Effect of Age on Adjuvant Cisplatin-Based Chemotherapy for Completely Resected Non–Small-Cell Lung Cancer

Martin Früh, Estelle Rolland, Jean-Pierre Pignon, Lesley Seymour, Keyue Ding, Hélène Tribodet, Timothy Winton, Thierry Le Chevalier, Giorgio V. Scagliotti, Jean Yves Douillard, Stephen Spiro, Frances A. Shepherd

From the Department of Medical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Trials Group, Queen‘s University, Kingston, Ontario; University of Alberta, Edmonton, Alberta, Canada; Meta-Analysis Unit; Department of Medicine, Institut Gustave-Roussy, Villejuif; Medical Oncology, Centre René Gauducheau, Nantes, France; Clinical and Biological Sciences, University of Turin, Torino, Italy; and the Department of Thoracic Medicine, University College Hospital, London, United Kingdom

Corresponding author: Martin Früh, MD, Department of Medical Oncology, Kantonsspital St Gallen, 9007 St Gallen, Switzerland; e-mail: martin.frueh{at}kssg.ch

Purpose This pooled analysis was undertaken to assess the efficacy and toxicity of adjuvant cisplatin-based chemotherapy in elderly patients with non–small-cell lung cancer (NSCLC).

Methods We used individual patient data from 4,584 patients enrolled onto five trials of cisplatin-based chemotherapy who form the basis for the Lung Adjuvant Cisplatin Analysis (LACE) pooled analysis. Patient and treatment characteristics, overall and event-free survival, cause-specific mortality, chemotherapy toxicity and delivery were compared among three age groups: 3,269 young (71%; < 65), 901 midcategory (20%; 65 to 69), and 414 elderly patients (9%; 70). Log-rank tests stratified by trials were used with a test for trend to study the effect of chemotherapy on survival according to age.

Results The hazard ratio (HR) of death for the young patients was 0.86 (95% CI, 0.78 to 0.94), 1.01 for the midcategory (95% CI, 0.85 to 1.21), and 0.90 for elderly patients (95% CI, 0.70 to 1.16; test for trend: P = .29). The HR for event-free survival was 0.82 for young (95% CI, 0.75 to 0.90), 0.90 for the midcategory (95% CI, 0.76 to 1.06), and 0.87 for elderly patients (95% CI, 0.68 to 1.11; test for trend: P = .42). More elderly patients died from non–lung cancer–related causes (12% young, 19% midcategory, 22% elderly; P < .0001). No differences in severe toxicity rates were observed. Elderly patients received significantly lower first and total cisplatin doses, and fewer chemotherapy cycles (² P < .0001).

Conclusion Adjuvant cisplatin-based chemotherapy should not be withheld from elderly patients with NSCLC purely on the basis of age.

Supported in part by Programme Hospitalier de Recherche Clinique, Ligue Nationale Contre le Cancer; Sanofi-Aventis; a research fellowship to M. Früh from Sanofi-Aventis, Canada, Walter Honegger Foundation, and Krebsliga St Gallen-Appenzell. F.A.S. holds the Scott Taylor Chair in Lung Cancer Research.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

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

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