Análise de sobrevida e tolerabilidade a quimioterapia baseada em compostos platínicos em pacientes portadores de câncer de pulmão de células não-pequenas com idade superior a 70 anos
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Data
2006
Autores
Costa, Guilherme Jorge [UNIFESP]
Orientadores
Fernandes, Ana Luisa Godoy [UNIFESP]
Tipo
Dissertação de mestrado
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INTRODUÇÃO: A terapia combinada para carcinoma de pulmão de células nãopequenas (CPCNP) é bem conhecida, porém sua utilização em pacientes idosos não está bem estabelecida. OBJETIVO: Avaliar se o envelhecimento compromete a sobrevida e exacerba a toxicidade dos pacientes portadores de carcinoma de
pulmão, doença avançada, em quimioterapia baseada em compostos platínicos. MÉTODOS: Nós realizamos estudo caso-controle aninhado em uma coorte de
pacientes sem quimioterapia prévia, diagnosticados de Janeiro de 98 a Dezembro
de 03. Eram casos, pacientes consecutivos, com CPCNP e idade superior a 70
anos, e os controles eram um subgrupo de pacientes, com idade inferior a 70
anos, estratificados para o estadiamento da doença e o ano no qual eles foram
tratados. Todos os pacientes foram tratados com cisplatina (60-80mg/m2) ou
carboplatina (4-6 AUC), a cada 4 semanas, associada a vinorelbine (30mg/m2) por
um máximo de 6 ciclos. A história clínica, exame físico e estadiamento do tumor
foram realizados na primeira visita e a cada mês. A sobrevida foi calculada pelo
método de Kaplan-Meier e log-rank test foi usado para a comparação das curvas.
Teste de qui-quadrado foi usado para comparar dos dois grupos quanto aos
efeitos colaterais. RESULTADOS: Total de 419 pacientes foi avaliado em estudo
caso-controle (205 pacientes acima de 70 anos / 219 menos 70 anos) com 3,6
ciclos por paciente, em média. Os dois e três anos de taxa de sobrevida foram
20,5% e 6,8% para pacientes idosos e 9,8% e 2,3% para pacientes jovens (p=
0,017 e 0,014 respectivamente para 2 e 3 anos). A proporção de pacientes com
efeitos adversos, graus 3 e 4, foram a mesma em ambos os grupos (43,9% vs
43,9%; p=0.99). CONCLUSÕES: nossos resultados sugerem que idosos
submetidos à quimioterapia, para neoplasia de pulmão, evoluem tão bem quanto,
ou melhor que, pacientes de outras faixas etárias. Envelhecimento, por si só, não
deve excluir pacientes de receber quimioterapia baseada em platina, desde que
parece ser bem tolerada e efetiva para CPCNP.
BACKGROUND: The combination therapy for non-small cell lung cancer (NSCLC) with platinum-based regime is well known, but its utility in elderly has not been explored systematically. AIM: To examine whether aging compromises survival or exacerbates toxicity in patients with advanced lung cancer receiving platinumbased treatment. METHODS: We performed a nested case-control study in a cohort of chemotherapy naive patients enrolled Jan 98 - Dec 03. Cases were consecutive patients over 70 at diagnosis with stage III or IV NSCLC. Controls were a subset of patients under 70 years matched by stage and year in which they had been treated. All patients received cisplatin (60-80mg/m2) or carboplatin (4-6 AUC), every 4 wk, followed by vinorelbine (30mg/m2) for a maximum of 6 courses. The medical history, physical examination and tumor imaging evaluation were performed at baseline and then monthly. Survival was calculated by Kaplan-Meier method and log-rank test was used for survival comparisons. Chi-squared test was used to compare side effects in the two groups. RESULTS: A total of 419 patients were identified for the case-control study (205 elderly/219 young) with 3.6 cycles per patient, on average. The two and three years survival rates were 20.5% and 6.8% for elderly patients and 9.8% and 2.3% for younger patients (p=0.017 and 0.014 respectively for 2 and 3 years). The proportion of patients with adverse effects, either grade 3 or 4, was the same in both groups at two years (43.9% vs 43.9%; p=0.99). CONCLUSIONS: Although elderly patients may self-select or be selected to be healthier, our findings suggest that elderly patients currently undergoing chemotherapy for lung cancer do as well or better than younger patients. Elderly age alone should not preclude patients from receiving platinumbased chemotherapy, since it seems well tolerated and effective in non-small cell lung cancer among elderly patients.
BACKGROUND: The combination therapy for non-small cell lung cancer (NSCLC) with platinum-based regime is well known, but its utility in elderly has not been explored systematically. AIM: To examine whether aging compromises survival or exacerbates toxicity in patients with advanced lung cancer receiving platinumbased treatment. METHODS: We performed a nested case-control study in a cohort of chemotherapy naive patients enrolled Jan 98 - Dec 03. Cases were consecutive patients over 70 at diagnosis with stage III or IV NSCLC. Controls were a subset of patients under 70 years matched by stage and year in which they had been treated. All patients received cisplatin (60-80mg/m2) or carboplatin (4-6 AUC), every 4 wk, followed by vinorelbine (30mg/m2) for a maximum of 6 courses. The medical history, physical examination and tumor imaging evaluation were performed at baseline and then monthly. Survival was calculated by Kaplan-Meier method and log-rank test was used for survival comparisons. Chi-squared test was used to compare side effects in the two groups. RESULTS: A total of 419 patients were identified for the case-control study (205 elderly/219 young) with 3.6 cycles per patient, on average. The two and three years survival rates were 20.5% and 6.8% for elderly patients and 9.8% and 2.3% for younger patients (p=0.017 and 0.014 respectively for 2 and 3 years). The proportion of patients with adverse effects, either grade 3 or 4, was the same in both groups at two years (43.9% vs 43.9%; p=0.99). CONCLUSIONS: Although elderly patients may self-select or be selected to be healthier, our findings suggest that elderly patients currently undergoing chemotherapy for lung cancer do as well or better than younger patients. Elderly age alone should not preclude patients from receiving platinumbased chemotherapy, since it seems well tolerated and effective in non-small cell lung cancer among elderly patients.
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Citação
COSTA, Guilherme Jorge. Análise de sobrevida e tolerabilidade a quimioterapia baseada em compostos platínicos em pacientes portadores de Câncer de pulmão de células não-pequenas com idade superior a 70 anos. 2006. 73 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2006.