Carboplatin-containing regimens as front-line treatment for advanced non-small-cell lung cancer in two groups of elderly.

OBJECTIVES: We evaluated the impact of a carboplatin-based doublet in two groups of elderly patients with advanced non-small cell lung cancers (NSCLC). MATERIALS AND METHODS: A retrospective analysis of all consecutive elderly patients (≧70 year old) with advanced NSCLC who received a carboplatin-based doublet as front-line therapy at our medical oncology unit was performed. RESULTS: In the study, 57 consecutive elderly patients with advanced NSCLC were included. Carboplatin was combined with vinorelbine in 41 patients (71·9%) and with gemcitabine in 16 patients (28·1%). Overall, a total of 227 cycles were administered to 57 patients - 142 cycles were administered to patients in group 1 and 85 cycles were given to patients in group 2 - median number of administered cycles per patient was 4 (range 1-6). Of the patients, 35 (62%, group 1) were 'young-old' (70-74-year old) and 20 (38%, group 2) were 'old-old' (75-82-year old). Toxicity was mild in both subgroups (grade 3-4 neutropenia in 17·1% of group 1 and in 9·1% of group 2). At the univariate analysis, the median overall survival (OS) was 10·07 months (P = 0·789, 95% CI: 8·49-11·64), 10·1 months in group 1 and 9·8 months in group 2. CONCLUSIONS: This evaluation shows the safety and efficacy of a carboplatin-based doublet given as first-line chemotherapy in elderly advanced NSCLC patients. The combination with vinorelbine or gemcitabine is associated with a very good toxicity profile that does not seem to have a detrimental effect on efficacy.

Platinum doublets as first-line treatment for elderly patients with advanced non-small cell lung cancer.

AIMS AND BACKGROUND: More than 50% of patients with advanced non-small cell lung cancer are diagnosed in the elderly. Few prospective clinical data with cisplatin-based chemotherapy are available, and some authors have suggested that a non-platinum single agent should be the preferred form of cure in these patients. The aim of the study was to evaluate the efficacy and safety of first-line chemotherapy based on platinums (carboplatin or cisplatin) plus a third generation compound (vinorelbine or gemcitabine) in elderly patients with advanced non-small cell lung cancer in daily clinical practice. METHODS: A retrospective analysis of consecutive elderly (≥70 years of age) patients with advanced non-small cell lung cancer treated at our Medical Oncology Unit from February 2005 to September 2011 was performed. RESULTS: A total of 249 cycles of chemotherapy was administered to 62 patients (median age, 72 years; range, 70-81) presenting a median Charlson comorbidity index of 1 and a good ECOG PS (0-1, 52 patients; 2, 10 patients). The median number of cycles/patient was 4, and all 62 patients received a platinum-based doublet as first-line chemotherapy: 57 with carboplatin (92%) and 5 with cisplatin (8%). As best response to the treatment, 19 (31%) partial responses and 20 (32%) stable diseases were observed. Median overall survival was 9.8 months. Toxicity was mild; grade III-IV neutropenia was the most frequently observed side effect in 19 administered cycles (8%). CONCLUSIONS: Advanced non-small cell lung cancer in elderly patients can be safely treated with a platinum-based doublet. Observed toxicity is manageable, and overall survival is in keeping with data from the literature.

Tolerability of PLD/oxaliplatin regimen in recurrent ovarian cancer patients with previous fragility to carboplatin/paclitaxel treatment.

OBJECTIVES: This retrospective analysis aims at describing the safety profile of treatment with pegylated liposomal doxorubicin (PLD) and oxaliplatin in recurrent ovarian cancer patients who experienced myelotoxicity (principally neutropenia) during first line chemotherapy with carboplatin and paclitaxel. METHODS: We reviewed the medical records of patients with relapsed ovarian cancer treated with PLD/Oxaliplatin at the Istituto Oncologico Veneto (IOV)/IRCCS, Padua University between 2002 and 2008. RESULTS: A cohort of 16 patients who developed myelodepression and other toxicities of grade 3 to grade 4 during first line chemotherapy with carboplatin/paclitaxel, were selected for this retrospective study. Patients had developed predominantly grade 3 to grade 4 neutropenia and grade 1 to grade 3 thrombocytopenia as major toxicities during primary chemotherapy with carboplatin and paclitaxel. Following relapse or disease progression, PLD/oxaliplatin chemotherapy was administered at 30 to 35 and 70 mg/m(2), respectively, over 2 day, every 4 weeks. CONCLUSIONS: Complete regression and stabilization of bone marrow suppression and no allergic reactions were seen with PLD/oxaliplatin treatment. The estimated median overall survival was 51.2 months. PLD/oxaliplatin chemotherapy did not show hematological toxicity and was feasible and active in this group of pretreated frail patients.

Bevacizumab and glioblastomas, a single-centre experience: how disease history and characteristics may affect clinical outcome.

BACKGROUND: In 2009, bevacizumab, a monoclonal antibody to vascular endothelial growth factor, received accelerated approval by the United States Food and Drug Administration for the treatment of glioblastoma, based on its high response rate (RR) and 6-month progression-free survival (PFS-6). However, time to progression and overall survival (OS) were disappointing. Since 2008 have been data collected evaluating the safety and efficacy of bevacizumab in patients with relapsed malignant gliomas. PATIENTS AND METHODS: This is a retrospective review of adult patients with recurrent malignant gliomas treated with bevacizumab at a dose of 10 mg/kg every 14 days; some patients were also treated with irinotecan at a dose of 125 mg/m(2) every 14 days. Patients were evaluated for side-effects and clinical outcomes of response, progression and survival. RESULTS: Ten patients received bevacizumab and nine patients received the combination with irinotecan. Both single-agent bevacizumab and combination treatment were well-tolerated. RR was of 28% with no complete responses, PFS-6 was 20% and OS was 4.5 months (95% confidence interval: 3.07-5.98 months). CONCLUSION: Although well-tolerated, the efficacy of bevacizumab was somewhat disappointing, possibly due to the high rate of secondary high-grade gliomas in the studied patient cohort and the late use of bevacizumab in the course of the disease.

Good response to second-line bevacizumab and interferon-alpha in a sunitinib-refractory patient with metastatic renal cell carcinoma.

In recent years with the development of targeted agents such as bevacizumab, sunitinib, sorafenib, temsirolimus, and everolimus, the treatment of metastatic renal cell carcinoma has changed dramatically. In clinical practice, sunitinib and bevacizumab are reserved for first-line treatment, but despite various guidelines, optimal treatment is still uncertain. We present, for the first time, a case of a good response to second-line bevacizumab and interferon-alpha in a patient who failed classical sunitinib treatment.