***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: 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 PURPOSE Sufficient data are currently unavailable to assist in defining suitable regimens for patients ≥ 70 years with advanced non-small cell lung cancer ( NSCLC ) . METHODS Chemonaïve patients with a performance status ( PS ) of 0 or 1 and stage IIIB or IV NSCLC were r and omized to gemcitabine 1000mg/m(2 ) on days 1 and 8 plus carboplatin area under the curve ( AUC ) 5.5 on day 1 ; the same schedule of gemcitabine plus paclitaxel 200mg/m(2 ) on day 1 ; or paclitaxel 225mg/m(2 ) on day 1 plus carboplatin AUC 6.0 on day 1 . Cycles were every 21 days up to 6 . Efficacy and toxicity results were compared by age groups . RESULTS Overall survival ( OS ) between patients < 70 years ( 8.6 months , 95 % CI : 7.9 , 9.5 ) and ≥ 70 years ( 7.9 months , 95 % CI : 7.1 , 9.5 ) was similar . OS was 8.8 months ( 95 % CI : 7.5 , 10.3 ) among patients 70 - 74 years , 6.5 months ( 95 % CI : 5.6 , 9.3 ) among patients 75 - 79 years , and 7.9 months ( 95 % CI : 6.3 , 10.3 ) among patients ≥ 80 years . OS was lower among patients 75 - 79 years compared with patients 70 - 74 years ( P=0.04 ) . Compared with patients < 70 years , patients ≥ 70 years experienced similar rates of myelosuppresion , but younger patients experienced more vomiting and nausea . There was no clear pattern with respect to differences in efficacy by treatments across age groups . CONCLUSIONS Based on the similarity of patient outcomes across age groups , doublet chemotherapy is feasible among carefully selected elderly patients with good PS The toxicity and therapeutic activity , including the effect on quality of life , of the carboplatin-oral etoposide combination , given with an intrapatient dose escalation , was tested in 38 non-small cell lung cancer ( NSCLC ) patients aged over 70 years , and in 8 younger patients with a performance status of 2 . In the absence of grade 3 - 4 toxicity , doses were escalated as follows : first course ( carboplatin AUC 4 ; etoposide 50 mg twice daily orally days 1 - 14 ) ; second course ( carboplatin AUC 5 ; etoposide 50 mg twice daily orally days 1 - 14 ) ; third course ( carboplatin AUC 5 ; etoposide 50 mg twice daily orally days 1 - 21 ) . A total of 141 chemotherapy cycles were delivered . The treatment was , in general , well tolerated and no toxic deaths occurred . More than 60 % of patients received 100 % of the planned dose intensity . Transient grade 4 neutropenia or thrombocytopenia occurred in 6 and 2 patients , respectively , but only 2 patients had to be hospitalised because of fever . All patients were evaluated for activity on an ' intention to treat basis ' . Ten partial responses and 20 stable disease were recorded , for an overall response rate of 22 % ( 95 % confidence interval ( CI ) = 11 - 36 ) . 9/38 ( 24 % ; 95 % CI = 12 - 41 ) elderly patients obtained a partial response . The median response duration was 4 months . A quality of life improvement was observed in 19 of the 46 enrolled patients ( 41 % ; 95 % CI = 27 - 57 ) , and 15/46 ( 33 % ; 95 % CI = 19 - 48 ) showed a performance status improvement . The quality of life score improved in 17/38 ( 45 % ) elderly patients . 8/10 responders and 11/20 patients with stable disease showed a concomitant improvement in quality of life . At a median potential follow-up of 16 months ( range 2 - 21 ) , 31 patients had had progression of disease and 23 had died , for a median time to progression ( TTP ) and overall survival ( OS ) of 5 and 10 months , respectively . The median survival time was 11 months in the elderly patients . The median time to subjective impairment ( TSI ) was 6 months ( 7 months in the elderly group ) . One-year estimated TTP , TSI and OS rates were 22 , 29 and 41 % , respectively . At multivariate Cox analysis , a > 25 % improvement in the quality of life score was more predictive of a better survival outcome than the response achievement The optimal treatment strategy for elderly patients with advanced nonsmall cell lung carcinoma has not been defined to date . The authors performed a retrospective analysis of a Phase III trial that treated patients who had Stage IIIB or IV nonsmall cell lung carcinoma with carboplatin and paclitaxel and analyzed the impact of age on response rate , survival , toxicity , and quality of life The aim of this study was to compare the efficacy of single‐agent weekly docetaxel with the combination of docetaxel and gemcitabine in elderly and /or poor performance status patients with advanced nonsmall cell lung cancer ( NSCLC ) BACKGROUND Platinum-based doublet chemotherapy is recommended to treat advanced non-small-cell lung cancer ( NSCLC ) in fit , non-elderly adults , but monotherapy is recommended for patients older than 70 years . We compared a carboplatin and paclitaxel doublet chemotherapy regimen with monotherapy in elderly patients with advanced NSCLC . METHODS In this multicentre , open-label , phase 3 , r and omised trial we recruited patients aged 70 - 89 years with locally advanced or metastatic NSCLC and WHO performance status scores of 0 - 2 . Patients received either four cycles ( 3 weeks on treatment , 1 week off treatment ) of carboplatin ( on day 1 ) plus paclitaxel ( on days 1 , 8 , and 15 ) or five cycles ( 2 weeks on treatment , 1 week off treatment ) of vinorelbine or gemcitabine monotherapy . R and omisation was done central ly with the minimisation method . The primary endpoint was overall survival , and analysis was done by intention to treat . This trial is registered , number NCT00298415 . FINDINGS 451 patients were enrolled . 226 were r and omly assigned  monotherapy  and 225  doublet chemotherapy .  Median age was 77 years and median follow-up was 30.3 months ( range 8.6 - 45.2 ) . Median overall survival was 10.3 months for doublet chemotherapy and 6.2 months for monotherapy ( hazard ratio 0.64 , 95 % CI 0.52 - 0.78 ; p<0.0001 ) ; 1-year survival was 44.5 % ( 95 % CI 37.9 - 50.9 ) and 25.4 % ( 19.9 - 31.3 ) , respectively . Toxic effects were more frequent in the doublet chemotherapy group than in the monotherapy group ( most frequent , decreased neutrophil count ( 108 [ 48.4 % ] vs 28 [ 12.4 % ] ; asthenia 23 [ 10.3 % ] vs 13 [ 5.8 % ] ) . INTERPRETATION Despite increased toxic effects , platinum-based doublet chemotherapy was associated with survival benefits compared with vinorelbine or gemcitabine monotherapy in elderly patients with NSCLC . We feel that the current treatment paradigm for these patients should be reconsidered . FUNDING Intergroupe Francophone de Cancérologie Thoracique , Institut National du Cancer INTRODUCTION Elderly cancer patients are a very heterogeneous population . A comprehensive geriatric assessment ( CGA ) shall help to identify more precisely those patients who are fit , compared to those who are vulnerable or frail , when deciding on chemotherapeutical treatment . METHODS In a prospect i ve trial , 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit , vulnerable or frail . A CGA was performed thereafter . We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians ' judgement with the CGA results . RESULTS Physicians judged 64.3 % of their patients as fit , 32.4 % as vulnerable , and 3.2 % as frail . A CGA was completed by 97.5 % of patients and lasted 20min per patients ( range : 9 - 47min ) . 26.5 % of all patients had no deficits in the CGA . The CGA identified a mean of 1.7 problems per patient , 1.3 in patients judged as fit , 2.3 in those judged as vulnerable , and 4.2 in those judged as frail . A  CGA  is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians ' judgement . CONCLUSION A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians ' judgement . Further trials including disease and treatment related end-points are needed BACKGROUND Vinorelbine prolongs survival and improves quality of life in elderly patients with advanced non-small-cell lung cancer ( NSCLC ) . Some studies have also suggested that gemcitabine is well tolerated and effective in such patients . We compared the effectiveness and toxicity of the combination of vinorelbine plus gemcitabine with those of each drug given alone in an open-label , r and omized phase III trial in elderly patients with advanced NSCLC . METHODS Patients aged 70 years and older , enrolled between December 1997 and November 2000 , were r and omly assigned to receive intravenous vinorelbine ( 30 mg/m(2 ) of body surface area ) , gemcitabine ( 1200 mg/m(2 ) ) , or vinorelbine ( 25 mg/m(2 ) ) plus gemcitabine ( 1000 mg/m(2 ) ) . All treatments were delivered on days 1 and 8 every 3 weeks for a maximum of six cycles . The primary endpoint was survival . Survival curves were drawn using the Kaplan-Meier method and analyzed by the Mantel-Haenszel test . Secondary endpoints were quality of life and toxicity . RESULTS Of 698 patients available for intention-to-treat analysis , 233 were assigned to receive vinorelbine , 233 to gemcitabine , and 232 to vinorelbine plus gemcitabine . Compared with each single drug , the combination treatment did not improve survival . The hazard ratio of death for patients receiving the combination treatment was 1.17 ( 95 % confidence interval [ CI ] = 0.95 to 1.44 ) that of patients receiving vinorelbine and 1.06 ( 95 % CI = 0.86 to 1.29 ) that of patients receiving gemcitabine . Although quality of life was similar across the three treatment arms , the combination treatment was more toxic than the two drugs given singly . CONCLUSION The combination of vinorelbine plus gemcitabine is not more effective than single-agent vinorelbine or gemcitabine in the treatment of elderly patients with advanced NSCLC BACKGROUND Older patients , even if fit , are often considered incapable of tolerating platinum-based systemic therapy . We performed a retrospective analysis of Eastern Cooperative Oncology Group ( ECOG ) 5592 , a phase III r and omized trial of platinum-based chemotherapy regimens 
    Output:
    
CONCLUSIONS Doublets appear to be more effective and tolerable than single-agent therapy for treating elderly advanced NSCLC patients , and therefore could be considered as a treatment option for elderly population s with good physical status