title: Combination chemotherapy with irinotecan and cisplatin in elderly patients (>or= 65 years) with extensive-disease small-cell lung cancer.
abstract: BACKGROUND
  Combination chemotherapy with irinotecan and cisplatin is one of the standard treatments for patients with small-cell lung cancer (SCLC). In elderly patients, however, its efficacy and toxicity has not been well documented. In this Phase II study, we assessed the efficacy and toxicity of combination chemotherapy with irinotecan and cisplatin and examined whether advanced age compromises it in elderly patients with previously untreated extensive-disease small-cell lung cancer (ED-SCLC).
  
  
  METHODS
  In this study, 46 previously untreated elderly patients (65 years or older) with ED-SCLC were given combination chemotherapy consisting of irinotecan 60 mg/m(2) on days 1, 8 and 15 and cisplatin 60 mg/m(2) on day 1. The treatment was repeated every 4 weeks until patients completed the maximum six cycles.
  
  
  RESULTS
  Patients consisted of 37 men and 9 women, whose median age was 70 years (range 65-81 years). A complete response and a partial response were observed in 19.6% (9/46) and 56.5% (26/46), respectively. The overall response rate was 76.1% (95% C.I; 63.8-88.4%). The overall median survival was 10.4 months (range 7.6-13.2 months). The median progression-free survival was 8.32 months (range 6.8-9.8 months). Major toxicities included neutropenia (grade 3-4, 58.7%), leukopenia (grade 3-4, 49.9%), infection (grade 3-4, 39.1%) and diarrhea (grade 3-4, 30.4%). Incidence of febrile neutropenia was significantly higher in patients with ECOG performance status 2-3 compared with ECOG performance status 0-1 (70.4% vs. 5.2%; p<0.001). There were two treatment related deaths in patients ECOG performance status 3.
  
  
  CONCLUSIONS
  Our results indicate that combination chemotherapy with irinotecan and cisplatin is an effective treatment for elderly patients with ED-SCLC who have good ECOG performance status and physicians should be aware of the mortality and morbidity due to myelosuppression following this treatment in elderly ED-SCLC patients with poor ECOG performance status.
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea.
authors.forename: Hoon-Gu
authors.initials: HG
authors.lastname: Kim
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Myung-Hee
authors.initials: MH
authors.lastname: Kang
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Hwang
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.forename: Yi Yeong
authors.initials: YY
authors.lastname: Jeong
authors.forename: Ho-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Jong Duk
authors.initials: JD
authors.lastname: Lee
authors.forename: Jong-Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Young Sil
authors.initials: YS
authors.lastname: Hwang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002166:Camptothecin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced
chemical_list: D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin