This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. This resource has been made available to the research community through collaborative efforts of the National Cancer Institute (NCI) and the Centers for Medicare and Medicaid Services (CMS). We acknowledge the efforts of the NCI Applied Research Program, the CMS Office of Research, Development, and Information, Information Management Services, and the SEER Program tumor registries in the creation of the SEER-Medicare database.
Comparative effectiveness of three platinum-doublet chemotherapy regimens in elderly patients with advanced non–small cell lung cancer
Article first published online: 5 APR 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 11, pages 2048–2060, 1 June 2013
How to Cite
Zhu, J., Sharma, D. B., Chen, A. B., Johnson, B. E., Weeks, J. C. and Schrag, D. (2013), Comparative effectiveness of three platinum-doublet chemotherapy regimens in elderly patients with advanced non–small cell lung cancer. Cancer, 119: 2048–2060. doi: 10.1002/cncr.28022
- Issue published online: 20 MAY 2013
- Article first published online: 5 APR 2013
- Manuscript Accepted: 24 JAN 2013
- Manuscript Revised: 13 JAN 2013
- Manuscript Received: 5 DEC 2012
- non–small cell lung cancer;
- first-line chemotherapy;
- propensity score analysis;
Randomized trials report equivalent efficacy among various combinations of platinum-based regimens in advanced non–small cell lung cancer (NSCLC). Their relative effectiveness and comparability based on squamous versus nonsquamous histology is uncertain.
The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to identify first-line chemotherapy agents administered to Medicare beneficiaries with stage IIIB or IV NSCLC diagnosed from 2000 to 2007. Overall survival was compared between patients who received the 3 most common regimens: carboplatin-paclitaxel, carboplatin-gemcitabine, and carboplatin-docetaxel. Stratified analyses distinguished between the outcomes of patients with squamous versus nonsquamous cell histology. Multivariable Cox proportional hazards models and propensity score analyses facilitated adjustment for imbalance in measurable patient characteristics.
Of the 15,318 patients who received first-line chemotherapy, 43.1% received carboplatin-paclitaxel, 14.3% received carboplatin-gemcitabine, 8.5% received carboplatin-docetaxel, and 34.1% received other regimens. The median survival was 8.0 months (interquartile range [IQR], 3.5-17.4 months) for carboplatin-paclitaxel, 7.3 months (IQR, 3.4-15.2 months) for carboplatin-gemcitabine, and 7.5 months (IQR, 3.2-16.0 months) for carboplatin-docetaxel. Both multivariable and propensity score-adjusted Cox models demonstrated a slight inferiority associated with carboplatin-gemcitabine or carboplatin-docetaxel versus carboplatin-paclitaxel, with a hazard ratio of 1.10 (95% confidence interval, 1.04-1.15) and 1.09 (95% confidence interval, 1.02-1.16), respectively, in propensity score-stratified models. Among the subgroup of 2063 patients with squamous carcinoma, propensity score-stratified analyses had a higher risk of death (hazard ratio, 1.20; 95% confidence interval, 1.07-1.35) associated with carboplatin-gemcitabine versus carboplatin-paclitaxel.
Carboplatin-paclitaxel was associated with slightly better survival compared with carboplatin-gemcitabine or carboplatin-docetaxel within the Medicare population with advanced NSCLC, and this was most pronounced for patients who had squamous cell histology. Cancer 2013;119:2048–2060. © 2013 American Cancer Society.