Carboplatin plus pemetrexed for the elderly incurable chemo-naive nonsquamous non–small cell lung cancer: Meta-analysis

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Abstract

Aim

In some developed countries, a proportion of nonsquamous non–small cell lung cancer (NSq NSCLC) patients are aged over 70 years when they are diagnosed. However, evidence of lung cancer chemotherapy usually comes from randomized controlled trials that only recruit younger patients with good performance status. In daily practice, less-toxic carboplatin + pemetrexed regimen is often used for elderly patients, although this regimen is not sufficiently supported by rigid evidence for elderly cases.

Methods

The protocol was registered on PROSPERO website (42017058508). Any phase trial that evaluated the efficacy and safety of carboplatin + pemetrexed in the elderly (aged 70 or higher) was included. Binary data were meta-analyzed with the random-model generic inverse variance method. Median survival duration was pooled after logarithmic transformation.

Results

Eight studies consisting of 285 patients were included among 882 articles that met the preliminary criteria. The pooled median overall survival and progression-free survivals were 14.9 months (95% confidence interval [95% CI], 12.0–18.4) and 5.4 months (95% CI, 4.5–6.4), respectively. The pooled response rate was 34.0% (95% CI, 27.5–40.5). Hematological adverse events such as neutropenia (≥grade 3; 48.3%; 95% CI, 40.1–56.6), thrombocytopenia (≥grade 3; 27.9%; 95% CI, 15.8–39.9), and anemia (≥grade 3; 17.1%; 95% CI, 8.3–25.8) were frequently observed. However, febrile neutropenia (6.8%; 95% CI, 0.2–13.3), nausea (≥grade 3; 0%; 95% CI, 0.0–4.4%) and treatment-related death (0.6%; 95% CI, 0–5.4%) were rare.

Conclusion

Carboplatin + pemetrexed can be a good option for the treatment of the elderly with NSq NSCLC.

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