Dose Modification of Etoposide plus Platinum in Elderly Patients with Extensive-Disease Small-Cell Lung Cancer

Elderly patients with extensive-disease small-cell lung cancer (ED-SCLC) have a high risk of chemotherapy toxicity due to multiple comorbidities and poor performance status. Although dose modification is often used to avoid toxicity in elderly patients with ED-SCLC, there is little data on the effect of initial dose-reduced chemotherapy on survival outcomes.We retrospectively reviewed 100 elderly patients with ED-SCLC who received first-line etoposide plus platinum chemotherapy between January 2006 and December 2020.The median age was 74 years. Eighty-nine patients (89%) had a history of smoking, and 38 (38%) had chronic lung disease. Thirty-four patients (34%) received dose-reduced etoposide plus platinum in the first cycle. The dose-reduced group had significantly higher age, lower body mass index, and poor ECOG PS. There were no significant differences in survival outcomes between the dose-reduced and full-dose chemotherapy [median overall survival (OS), 4.9 vs. 6.5 months, p=0.440; median progression free survival (PFS), 3.7 vs. 4.6 months, p=0.272]. In multivariate analyses, dose reduction in the first cycle (hazard ratio 0.519, 95% CI 0.269-1.000, p=0.050) was significantly associated with OS. Following subgroup analysis of 59 patients who received minimum four cycles, no significant differences in survival outcomes between the two groups (median OS, 10.9 vs. 9.4 months, p=0.817; median PFS, 6.3 vs. 6.5 months, p=0.902) was noted.The dose-reduced chemotherapy with first-line etoposide plus platinum had non-inferior survival outcomes compared to the full-dose chemotherapy in elderly patients with ED-SCLC.