Poor performance status patients with advanced non-small cell lung cancer (NSCLC) have frequently been excluded from clinical trials due to the perception that they would have excessive treatment-related toxicity and a limited life expectancy. A recent retrospective review of two multicenter trials of patients who were treated with platinum-based chemotherapy for advanced NSCLC showed that patients with poor performance status treated with platinum based chemotherapy have a similar rate of toxicity compared to good performance status patients. Their overall survival was lower despite a similar response to chemotherapy. Current guidelines, do not advise platin based chemotherapy for patients in poor ECOG performance status, 3-4. In addition, this patient has brain mets, which is not a contraindication but does make benefit from chemotherapy less likely.
NCCN states: “New agents/ non-latinum combnations arereasonable alternatives if available phase I/II studies show activity and tolerable toxicity”. http://nccn.org/professionals/physician_gls/PDF/nscl.pdf
STINCHCOMBE Thomas E et al, Carboplatin-based chemotherapy in patients with advanced non-small cell lung cancer and a poor performance status Lung cancer 2006, vol. 51, no2, pp. 237-243
Lung Cancer Disease Site Group. Chemotherapy in stage IV (metastatic) non-small cell lung cancer. Toronto (ON): Cancer Care Ontario (CCO); 2005 Jan. 22 p. (Practice guideline report; no. 7-2). [28 references]