Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study.
BACKGROUND
Elderly patients with advanced non-small-cell lung cancer (NSCLC) may derive similar benefit from platinum-based chemotherapy as younger patients. Quality of life (QoL) and comprehensive geriatric assessment (CGA) is often advocated to assess benefits and risks.


METHODS
A total of 181 chemotherapy-naive patients [≥70 years, performance score (PS) of 0-2] with stage III-IV NSCLC received carboplatin and gemcitabine (CG) (n = 90) or carboplatin and paclitaxel (CP) (n = 91) every 3 weeks for up to four cycles. Primary end point was change in global QoL from baseline compared with week 18. Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken. A principal component (PC) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival.


RESULTS
There were no changes in QoL after treatment. The number of QoL responders (CG arm, 12%; CP arm, 5%) was not significantly different. CGA items were only associated with neuropsychiatric toxicity. Quality-adjusted survival was not different between treatment arms. The PC analysis derived from nine CGA, six QoL and one PS score indicated only one dominant dimension. This dimension was strongly prognostic, and physical and role functioning, Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors.


CONCLUSIONS
Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner. CGA and QoL items measure one underlying dimension, which is highly prognostic.
Department of Pulmonology, Jeroen Bosch Hospital, 's-Hertogenbosch.
B
B
Biesma
Department of Internal Medicine, Medisch Spectrum Twente, Enschede.
A N M
ANM
Wymenga
Biometrics Department, Netherlands Cancer Institute, Amsterdam.
A
A
Vincent
Biometrics Department, Netherlands Cancer Institute, Amsterdam.
O
O
Dalesio
Department of Pulmonology, Alysis Zorggroep, Location Rijnstate Hospital, Arnhem.
H J M
HJM
Smit
Department of Pulmonology, Isala Clinics, Zwolle.
J A
JA
Stigt
Department of Pulmonology, VU Medical Center, Amsterdam.
E F
EF
Smit
Department of Pulmonology, Twenteborg Hospital, Almelo.
C L
CL
van Felius
Department of Pulmonology, Martini Hospital.
J W G
JWG
van Putten
Department of Internal Medicine.
J P J
JPJ
Slaets
Department of Pulmonology, University Medical Center, Groningen, The Netherlands. Electronic address: h.j.m.groen@long.umcg.nl.
H J M
HJM
Groen
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000188:drug therapy / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D018287:Carcinoma, Large Cell / Q000188:drug therapy / Q000401:mortality; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
D003841:Deoxycytidine; D016190:Carboplatin; D017239:Paclitaxel; D000093542:Gemcitabine