A senior moment.

Balancing the benefits and risks of cytotoxic chemo is particularly challenging for the elderly, especially given how few clinical trials have included them. Here’s a rare prospective phase 3 trial from Japan designed just for patients 75 years and older with advanced non-small cell lung cancer (NSCLC). 433 patients with no targetable mutations were randomized to upfront standard docetaxel monotherapy versus combo carboplatin + pemetrexed followed by pemetrexed maintenance. The design was to establish non-inferiority of the latter, which was established with a median overall survival of 16 months with docetaxel and 19 months with carbo + pem. What’s more, and possibly related, the carbo + pem arm required less dose reductions due to significantly lower rates of leukopenia, neutropenia, and febrile neutropenia. TBL: For patients ≥75 years old, carboplatin and pemetrexed is currently the cytotoxic chemo of choice. | Okamoto, JAMA Oncol 2020