Second-line chemotherapy with a modified schedule of docetaxel in elderly patients with advanced-stage non-small-cell lung cancer

Abstract

Purpose: In patients with advanced-stage non-small-cell lung cancer (NSCLC) pretreated with chemotherapy, docetaxel 75 mg/m2 every 3 weeks prolongs survival compared with best supportive care alone or chemotherapy with ifosfamide or vinorelbine. Neutropenia is the dose-limiting toxicity of this schedule, and thus limits its use in elderly patients. Therefore, we studied a modified schedule of docetaxel in order to reduce the toxicity of this regimen and to improve the compliance to treatment in an elderly population, while maintaining the same dose intensity of the original regimen.

Patients and methods: Thirty-three elderly patients (aged > or = 70 years) with advanced-stage NSCLC, Eastern Cooperative Oncology Group performance status 0-2, and a median age of 74 years (range, 70-83 years) who had progressed after 1 line of chemotherapy were treated with docetaxel 37.5 mg/m2 on days 1 and 8 every 3 weeks for a maximum of 6 courses.

Results: Seven of 33 patients (21.2%; 95% confidence interval, 8.98%-38.91%) exhibited a partial response (according to the intent-to-treat analysis), 12 patients (36.3%) exhibited stable disease, and 14 patients (42.4%) exhibited progression. Grade 3 (National Cancer Institute Common Toxicity Criteria) neutropenia and anemia were observed in 9% and 3% of patients, respectively. The main nonhematologic toxicity consisted of grade 3 nausea/vomiting, diarrhea, and asthenia in 6% of patients each, and grade 3 nail toxicity in 3% of patients.

Conclusion: Our modified schedule of docetaxel is an active and well-tolerated second-line treatment in elderly patients with advanced-stage NSCLC and has a favorable toxicity profile.