Survival and Toxicity After Cisplatin Plus Etoposide Versus Carboplatin Plus Etoposide for Extensive Stage Small Cell Lung Cancer in Elderly Patients.
PURPOSE Elderly patients with cancer are under represented in clinical trials and risk greater toxicity from chemotherapy. These patients and their physicians need better evidence to decide among guideline recommended regimens. We test whether patients with extensive stage small cell lung cancer (ES SCLC) have noninferior survival and less hospital based health care after carboplatin/etoposide compared with cisplatin/etoposide. METHODS We analyzed SEER Medicare data for beneficiaries with ES SCLC diagnosed at age 67 years and older between 1995 and 2009. Among patients treated with first line chemotherapy in the ambulatory setting, 831 received cisplatin/etoposide and 2,846 received carboplatin/etoposide. Propensity score matching (2:1 ratio) yielded 778 cisplatin/etoposide and 1,502 carboplatin/etoposide patients. RESULTS Survival was nearly identical in the two groups: 35.7 weeks for cisplatin/etoposide and 35.9 weeks for carboplatin/etoposide. The hazard ratio of 1 (95% CI, 0.91 to 1.09) excluded our prespecified threshold, indicating noninferiority. Mortality at 6 months was indistinguishable: 35% for cisplatin/etoposide and 34% for carboplatin/etoposide. After carboplatin/etoposide, patients were less likely to be admitted to a hospital (80% v 86% P .001) and had fewer hospitalizations (median 1 v 2, odds ratio 0.76, 95% CI, 0.65 to 0.9) ED visits (median 1 v 2, odds ratio 0.82, 95% CI, 0.7 to 0.96) and ICU stays (median 0 v 0, odds ratio 0.82, 95% CI, 0.69 to 0.99) CONCLUSION First line carboplatin/etoposide is associated with similar survival and less subsequent hospital based health care use than cisplatin/etoposide among elderly patients with ES SCLC treated in ambulatory settings.
Journal of oncology practice