Meeting the chemotherapy needs of elderly and poor performance status patients with NSCLC

Increasing interest in designing chemotherapy suitable for use in the elderly and in poor performance status (PS) patients has led to clinical trials in advanced non-small cell lung cancer (NSCLC) which have demonstrated a number of important points. First, the randomized Elderly Lung Cancer Vinorelbine Study Group (ELVIS) trial makes clear that elderly patients treated with vinorelbine plus best supportive care (BSC) have significantly improved survival and quality of life when compared with patients treated with BSC alone. Secondly, the Multicenter Italian Lung Cancer in the Elderly Study (MILES) trial demonstrates that the combination of gemcitabine plus vinorelbine in this patient population does not further improve survival or quality of life as compared to single chemotherapy with vinorelbine or gemcitabine. Weekly docetaxel has considerable potential among patients judged likely to tolerate poorly cisplatin-based chemotherapy. In a trial among 39 previously untreated elderly, poor PS or medically compromised patients, weekly 36 mg/m(2) docetaxel produced a 19% response rate and 28% 1-year survival. These data compare favorably with results achieved with other single agents. Weekly, docetaxel is better tolerated than the q 3-week schedule, and myelosuppression is not severe. Weekly docetaxel is also active as second-line therapy. The combination of gemcitabine and docetaxel, both administered weekly, is well tolerated by elderly and/or poor PS patients, is active (median survival 7 months, 1-year survival 29%) and merits further study.