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Docetaxel As Monotherapy in the Treatment of Advanced Non–Small-Cell Lung Cancer in Elderly Patients

Department of Hematology/Oncology, Heartland Regional Medical Center, St Joseph, MO

Jaswinder Singh, Sarah A. Taylor

Department of Hematology and Oncology, Kansas University Medical Center, Kansas City, KS

To the Editor:

The West Japan Thoracic Oncology Group (WJTOG) trial 9904 by Kudoh et al¹regarding taxane monotherapy in the treatment of elderly patients with non–small-cell lung cancer (NSCLC) is very encouraging. The authors randomly assigned elderly patients age 70 years or older with stage IIIB or IV NSCLC to either docetaxel or vinorelbine monotherapy. Patients in the docetaxel arm had an improved progression-free survival rate (5.5 months v 3.1 months), response rate (22.7% v 9.9%), and improved disease-related symptoms when compared with patients on the vinorelbine arm. Based on these results, the authors recommended that docetaxel monotherapy should be considered an option in the standard treatment of elderly patients with NSCLC. However, the results have to be considered in the context of the patient population included in this study. The majority of patients (96%) included in the study had good performance status (Eastern Cooperative Group [ECOG], 0 to 1), three fourths of the patients never smoked, and more than half of the patients had no comorbid illness. This is in contrast to most of the patients with NSCLC in North America. These patients are more likely to be smokers, have several comorbid conditions, and have a relatively lower performance status.

As reported by Gridelli et al² in the Multicenter Italian Lung Cancer in the Elderly Study (MILES) of elderly patients with NSCLC, two thirds of the patients had four or more associated comorbid illnesses and at least half of them had poor performance status.

Performance status is also known to be a predictor of outcomes in NSCLC. As shown in the study of advanced NSCLC by Georgoulias et al,³ patients with good performance status had significantly longer survival rates when compared with patients with poor performance status. Because almost all patients in Kudoh et al¹ had good performance status, and half of them had no other comorbid illnesses, it would be interesting to know the response and survival rates in relation to the group of patients with other comorbid illnesses.

The better patient profile and/or the additive effect of geftinib treatment to which Japanese patients are more likely to respond (37% of patients in the docetaxel arm received geftinib) may have contributed to the results.

Also, it would be interesting to know whether corticosteriods were given with chemotherapy, and if so how much was administered, as corticosteriods could account for some of the improved quality of life scores in these patients. Last, it would be useful to know the incidence of nail changes and fluid retention associated with docetaxel, as severe nail changes and fluid retention is reported to occur in 5% to 10% of these patients.

In conclusion, single-agent docetaxel could be a reasonable option for patients who would fit the patient profile of Kudoh et al¹, otherwise it is not clear whether the relatively good results seen in this study could be generalized to other less favorable patient profiles commonly seen in this country.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Kudoh S, Takeda K, Nakagawa K, et al: Phase III study of docetaxel compared with vinorelbine in elderly patients with advanced non–small-cell lung cancer: Results of West Japan Thoracic Oncology Group trial (WJTOG 9904). J Clin Oncol 24:3657-3663, 2006[Abstract/Free Full Text]

2. Gridelli C, Perrone F, Gallo C, et al: Chemotherapy for elderly patients with advanced non-small cell lung cancer: The Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst 95:362-372, 2003[Abstract/Free Full Text]

3. Georgoulias V, Ardavanis A, Agelidou A, et al: Docetaxel versus docetaxel plus cisplatin as frontline treatment of patients with advanced non-small-cell lung cancer: A randomized multicenter phase III trial. J Clin Oncol 22:2602-2609, 2004[Abstract/Free Full Text]

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