***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A r and omized trial of vinorelbine plus gemcitabine followed by docetaxel ( VGD ) versus paclitaxel plus carboplatin ( PC ) in patients with advanced non-small-cell lung cancer showed no difference in overall survival ( median survival time : 13.6 versus 14.1 months ) between the two treatment groups . We report here the results of quality -of-life ( QOL ) study initiated in the mid-course of this r and omized trial . Methods The patients themselves assessed the  Functional Assessment of Cancer Therapy (FACT)-Lung ( FACT-L ) , FACT-Taxane and the Functional Assessment of Chronic Illness Therapy - Spirituality ( FACIT-Sp ) QOL instruments at baseline and 6 , 12 and 18 weeks after the treatment . The primary endpoint was a comparison of total QOL score for each assessment instrument between the two groups . Results Sixty-eight patients from the trial ( VGD , 34 ; PC , 34 ) who su bmi tted baseline question naires and at least one question naire over the course of treatment were eligible . Longitudinal analysis showed a significant difference in slope of the FACT-Taxane score ( p = 0.004 ) between treatment regimens over time , but no difference was found in FACT-L score ( p = 0.311 ) and FACIT-Sp score ( p = 0.466 ) between the two groups . Conclusions The significant difference in slope of FACT-Taxane score favored the VGD regimen . These data should be considered in treatment decision-making for patients with advanced non-small-cell lung cancer . Trial registration NCT00242983 Summary We studied the efficacy of cisplatin-based polychemotherapy for adenocarcinoma of the lung . A total of 136 patients were r and omized for treatment with either cyclophosphamide , Adriamycin , cisplatin and mitomycin C ( CAPM ) or mitomycin C , cytosine arabinoside and tegafur ( MCT ) . Radiation was given to the chests of patients at stage III . The differences in the response rate ( 35 % in the CAPM arm and 13 % in the MCT arm ) were statistically significant ( P < 0.01 ) . However , the significant difference was observed in stage-IV patients ( CAPM , 33 % ; MCT , 4%;P < 0.001 ) and not in stage-III patients ( CAPM , 40 % ; MCT , 40 % ) . The median period of survival was 9.5 months for the CAPM arm and 5.5 months for the MCT arm ( P < 0.035 , Wilcoxon-Gehan test;P < 0.1 , log-rank test ) . Improved median survival for the CAPM regimen was demonstrated only by stage-IV patients ( CAPM , 10 months ; MCT , 5.5 months;P < 0.025 , Wilcoxon-Gehan test;P < 0.05 , log-rank test ) . The duration of the response , including PRs and NCs , was significantly different depending on the treatment , showing 5 months for the CAPM arm and 3 months for the MCT arm ( P < 0.05 ) . The significant difference was also only observed in stage-IV patients . Myelosuppression was more severe with CAPM than with the MCT regimen . Nausea and vomiting were significantly increased in patients receiving the CAPM regimen . However , all toxicities were acceptable and there were no treatment-related deaths . We concluded that cisplatin-based chemotherapy , CAPM therapy , was of more benefit to patients with adenocarcinoma of the lung than MCT therapy The aim of this study was to assess whether a combination of gemcitabine ( GEM ) with either paclitaxel ( PTX ) or vinorelbine ( VNR ) could be more effective than GEM or PTX alone in elderly or unfit advanced non-small-cell lung cancer ( NSCLC ) patients . A total of 264 NSCLC patients aged > 70 years with ECOG performance status (PS)⩽2 , or younger with PS=2 , were r and omly treated with : GEM 1200 mg m−2 on days 1 , 8 and 15 every 28 days ; PTX 100 mg m−2 on days 1 , 8 and 15 every 28 days ; GEM 1000 mg m−2 plus PTX 80 mg m−2 ( GT ) on days 1 and 8 every 21 days ; GEM 1000 mg m−2 plus VNR 25 mg m−2 ( GV ) on days 1 and 8 every 21 days . In all arms , an intra- patients dose escalation was applied over the first three courses , provided that no toxicity of WHO grade ⩾2 had previously occurred . At present time , 217 ( 82 % ) patients had died . The median ( months ) and 1-year survival probability were 5.1 and 29 % for GEM , 6.4 and 25 % for PTX , 9.2 and 44 % for GT , and 9.7 and 32 % for GV . Multivariate analysis showed that PS⩽1 ( hazard ratio (HR)=0.67 ; 95 % CI 0.51–0.90 ) , and doublet treatments ( HR=0.76 ; 95 % CI 0.59–0.99 ) were significantly associated with longer survival . Doublets produced no more toxicity than single agents . GT should be considered a reference regimen for elderly NSCLC patients with PS⩽1 We present experience from a phase II r and omized clinical trial , comparing st and ard gemcitabine as monotherapy with low-dose gemcitabine in long infusion in a doublet with cisplatin at reduced dose for patients with non-small cell lung cancer ( NSCLC ) and who are unfit for st and ard platin-based chemotherapy . Eligible patients had microscopically confirmed NSCLC in stage IIIB ( wet ) or IV , were chemo-naive , and were in poor performance status or presented with significant comorbidity .  St and ard treatment with gemcitabine , 1250 mg/m2 in 20–30 min on days 1 and 8 as monotherapy ( arm A ) was compared with low-dose gemcitabine in long infusion ( 200 mg/m2 in 6 h on day 1 ) and cisplatin at 60 mg/m2 on day 2 ( arm B ) . Both treatment schedules were repeated every 3 weeks until disease progression , unacceptable toxicity , or to a maximum of six cycles . A total of 112 patients ( 83 male , 29 female , median age 66 years ) were r and omized between arm A ( 57 patients ) and B ( 55 patients ) . The two groups were balanced for prognostic factors . Fifty-three patients in arm A and 52 in arm B received at least one application of chemotherapy and were evaluable for toxicity and response . The median number of cycles was four and five for arms A and B , respectively . Except for grade 3 anemia ( one patient in arm A and two in arm B ) , no other major toxicity was seen . Regarding response to treatment , arm B was superior : 1 complete response and 13 partial remissions ( response rate 26.9 % ) as compared with five partial remissions ( response rate 9.4 % ) in arm A ( P<0.01 ) . The median time to progression was 3.8 and 5.6 months , and the median survival was 4.3 and 6.8 months for arms A and B , respectively ( P<0.05 ) . Treatment with low-dose gemcitabine in long infusion and cisplatin at reduced dose has very low toxicity , is effective , was found to be superior to monotherapy with gemcitabine in st and ard doses , and is suitable for patients with NSCLC who can not tolerate a st and ard platin-based doublet PURPOSE The objective of this trial was to compare two vinorelbine-based doublets with carboplatin ( CBDCA-VC ) or with gemcitabine ( VG ) in patients with stage IIIB-IV non-small cell lung cancer ( NSCLC ) . PATIENTS AND METHODS A total of 316 patients with advanced NSCLC previously untreated were r and omized to either vinorelbine 30 mg/m(2 ) D1,8 with carboplatin AUC 5 D1 ( VC ) or vinorelbine 25mg/m(2 ) with gemcitabine ( VG ) 1000 mg/m(2 ) both given D1,8 every 3 weeks . The primary endpoint was response rate with secondary parameters being survival ( OS ) , progression-free survival ( PFS ) , tolerance and clinical benefit . RESULTS The median number of cycles was four in each arm with a total of 1268 cycles . The objective response ( OR ) on intent-to-treat was 20.8 % in VC and 28 % in VG ( p=0.15 ) . Median PFS was 3.9 months in VC and 4.4 months ( mo ) in VG ( p=0.18 ) . Median survival was significantly longer ( p=0.01 ) for VG with 11.5 mo compared to 8.6 mo in VC with 1 year survival at 48.9 and 34.4 % , respectively . Tolerance was better in the VG arm as compared to the VC patients . Four toxic deaths were recorded in the VC group . Clinical benefit response rate was 32.4 % compared to 40.9 % in 111 and 110 evaluable patients in VC and VG , respectively . CONCLUSION VG compared to VC result ed in a similar overall response rate , favourable median survival and a better toxicity profile . For non-cisplatin-based chemotherapy , VG is a useful alternative PURPOSE To compare mitomycin C plus vindesine plus etoposide ( MEV ) vs. mitomycin C plus vindesine plus cisplatin ( MVP ) in the treatment of stage IV non-small-cell lung cancer . PATIENTS AND METHODS 204 patients were entered in a phase III multicentre r and omised trial from June 1990 to December 1994 and stratified according to the ECOG performance status ( 0 - 1 vs. 2 ) .  MVP was given in the following dosages : mitomycin C 8 mg/m2+vindesine 3 mg/m2+cisplatin 100 mg/m2 i.v . day 1 and vindesine 3 mg/m2 i.v . day 8 with cycles repeated every 4 weeks . MEV was given in the following dosages : mitomycin C 8 mg/m2+vindesine 3 mg/ m2 i.v . day 1 and etoposide 100 mg/m2 i.v . days 1 to 3 with cycles repeated every 3 weeks . For both treatments a maximum of 6 cycles was planned . Response and toxicity were evaluated according to WHO . Subjective responses were assessed by numerical scales . Analyses were made on the basis of intent to treat . RESULTS The objective response rate was 21.4 % ( 1 CR + 21 PR among 103 patients ) in the MEV and 28.7 % ( 1 CR + 28 PR among 101 patients ) in the MVP arm ( P = 0.48 ) . Symptoms were similar in the two arms . 196 patients progressed and 182 died . The median times to progression were 10 weeks ( 95 % CI 9 - 12 ) and 12 weeks ( 95 % CI 10 - 15 ) and median survivals were 29 weeks ( 95 % CI 25 - 36 ) and 28 weeks ( 95 % CI 25 - 35 ) in the MEV and MVP arms , respectively . The relative risks of progressing and of dying were 0.89 ( 95 % CL 0.66 - 1.20 ) and 0.96 ( 95 % CL 0.71 - 1.30 ) , respectively , for patients receiving MVP as compared with those receiving MEV at multivariate analysis adjusted by sex , age , histologic type , number of metastatic sites , performance status at entry , and centre . CONCLUSIONS In the present study , no significant differences were observed in response rate , survival or palliation of symptoms between the MEV and MVP regimens , while toxicity was significantly more frequent and severe with MVP . Thus , MEV should be considered a reasonable alternative to the MVP regimen in the treatment of stage IV NSCLC Introduction : This r and omized phase II trial evaluated single-agent pemetrexed or sequential pemetrexed/gemcitabine in patients with non-small cell lung cancer ( NSCLC ) who were elderly ( ≥70 years ) or younger than 70 years and ineligible for platinum-based chemotherapy .  Methods : Chemonaive patients with stage IIIB/IV NSCLC and an Eastern Cooperative Oncology Group performance status of 0 to 2 received either 500 mg/m2 of pemetrexed ( day 1 , every 3 weeks ) for eight cycles , or the same dosage of pemetrexed for cycles 1 and 2 and then 1200 mg/m2 of gemcitabine ( days 1 and 8 , every 3 weeks ) for cycles 3 and 4 ( repeated once for a total of eight cycles ) . All patients were given vitamin B12 and folic acid supplementation . Results : From July 2003 to July 2004 , 87 patients ( 44 pemetrexed ; 43 pemetrexed/gemcitabine ) received treatment .  The median time to progression was 4.5 ( 95 % confidence interval : 3. 
    Output:
    
In people over the age of 70 with advanced NSCLC who do not have significant co-morbidities , increased survival with platinum combination therapy needs to be balanced against higher risk of major adverse events when compared with non-platinum therapy .
For people who are not suitable c and i date s for platinum treatment , we have found low- quality evidence suggesting that non-platinum combination and single-agent therapy regimens have similar effects on survival .