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A Phase II Study of Weekly Paclitaxel in Elderly Patients with Advanced Non-Small Cell Lung Cancer¹

Massachusetts General Hospital, Division of Hematology-Oncology [P. F., J. G. S., R. M., A. B., R. C., M. G., P. O., T. J. L.], and Dana Farber Cancer Institute, Department of Adult Oncology, Department of Medicine, Brigham and Women’s Hospital [G. S., J. L., B. E. J., A. S.], Harvard Medical School, Boston, Massachusetts 02114

Purpose: Our aim was to evaluate the efficacy, toxicity, and pharmacokinetic behavior of single-agent paclitaxel given weekly to elderly patients with lung cancer.

Experimental Design: Previously untreated patients with stage IIIB/IV non-small cell lung cancer were eligible for the study if they were at least 70 years of age and had preserved organ function. Paclitaxel was administered over 1 h at a dose of 90 mg/m² for 6 consecutive weeks on an 8-week cycle. The pharmacokinetics of paclitaxel were assessed during the first and sixth week of therapy in a subgroup of eight patients.

Results: A total of 35 patients (median age, 76 years; range, 70–85) were enrolled. The overall response rate was 23%. Median time to failure was 5.2 months, whereas the median survival time was 10.3 months. Survival rates after 1 and 2 years were 45 and 22%, respectively. Grade 3/4 toxicities included neutropenia (5.8%), hyperglycemia (17.6%), neuropathy (5.8%), and infection (8.8%). Two patients died from treatment-related toxicity. There was no significant difference (P = 0.18) between the total body clearance of paclitaxel on the first (17.4 ± 2.9 liters/h/m², mean ± SD) and sixth (15.8 ± 4.1 liters/h/m²) week of therapy.

Conclusion: Paclitaxel administered as a weekly 1-h infusion at a dose of 90 mg/m² is a safe and effective therapy for elderly patients with advanced non-small cell lung cancer. Its pharmacokinetics in elderly patients do not appear to differ from historical data for younger patients, and there was no suggestion of a change in drug clearance after repeated weekly dosing.

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