Phase I Study of Carboplatin Combined with Pemetrexed for Elderly Patients with Advanced Non-squamous Non-small Cell Lung Cancer

Objective: The primary objective of this study was to evaluate the safety and tolerability of carboplatin plus pemetrexed for elderly patients ( 75 years) with chemotherapy-naive advanced non-squamous non-small cell lung cancer. Methods: Patients received escalated doses of carboplatin at an area under the concentration–time curve of 4 (Level 1) or 5 (Level 2) plus pemetrexed (500 mg/m) every 3 weeks for a maximum of six cycles. Dose escalation was decided according to whether dose-limiting toxicity occurred in the first cycle of chemotherapy. Results: A total of 20 patients (6 at Level 1, 14 at Level 2) were enrolled. No dose-limiting toxicities were observed in patients at Level 1 or the first six patients at Level 2, and therefore the combination of carboplatin at an area under the concentration–time curve of 5 plus pemetrexed at 500 mg/m was considered to be the recommended dose. Among a total of 14 patients in Level 2, only 1 patient experienced dose-limiting toxicity: Grade 3 febrile neutropenia and urticaria. The major toxicities were neutropenia, thrombocytopenia and anemia. Liver dysfunction, fatigue and anorexia were also common, but generally manageable. Six patients showed partial responses, giving the overall response rate of 30%. The median progression-free survival period was 4.8 months (95% confidence interval 2.9–6.7 months). Conclusions: The combination of carboplatin at an area under the concentration–time curve of 5 plus pemetrexed at 500 mg/m was determined as the recommended dose in chemotherapy-naive elderly patients ( 75 years) with advanced non-squamous non-small cell lung cancer, in view of overall safety and tolerability.