“There is a perception within the medical field that elderly patients cannot tolerate combined or aggressive chemotherapy regimens and therefore are often prescribed single agent or best supportive care alone,” says Corey Langer, MD, director of thoracic and head and neck medical oncology at Fox Chase Cancer Center and lead author on the paper. “This study proves that relatively fit elderly patients can tolerate more aggressive chemotherapy to treat non-small cell lung cancer.”
In the retrospective analysis, medical records were evaluated of 574 patients who were diagnosed with non-small cell lung cancer, a slow-growing cancer, which accounts for 80 to 85 percent of the 170,000 cases of lung cancer diagnosed in the United States each year. Patients in the study had been given a fixed dose of cisplatin and randomly assigned to one of three distinct chemotherapy regimens, etoposide, high dose paclitaxel or low dose paclitaxel. When comparing results of older patients to younger patients, the researchers found no difference in the response rate to the drugs and the median and overall survival rates of older patients were comparable to the younger patients treated with the same agents. It was previously reported that most patients did better on the paclitaxel and cisplatin regimen.
Of the 574 patients, 86 of them were 70 years or older and 488 patients were under 70 years of age. Of the 488 patients under 70 years of age, 22 percent had either complete or partial response to treatment. And of the 86 participants 70 years or older, 23 percent achieved a complete or partial response. Overall average survival time in patients younger than 70 years was 9.05 months compared to 8.53 months in patients 70 or younger.
According to Langer, elderly patients are underrepresented in clinical trials, making it difficult to evaluate properly the efficacy and safety of current treatment options in this patient population. Moreover, the incidence of lung cancer rises with advancing age and it is highest in the 70 to 80 year-old age group. Forty-two percent of those newly diagnosed with non-small cell lung cancer are over 65 years of age and one-third are older than 70 years.
The researchers did find that among the elderly population psychological or neuro-cognitive distress was more pronounced than in their younger counterparts and that older men were slightly more inclined to develop neutropenia, a drop in the white blood cell count.
“Data from this trial, clearly demonstrates that the elderly do as well or as poorly as younger patients and that any decision to deny fit elderly patients access to protocol therapy is economic, not medical. Ultimately, functional status trumps age,” concludes Langer.
The trial was conducted in cooperation with the Eastern Cooperative Oncology Group (ECOG). Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at www.fccc.edu or call 1-888-FOX CHASE
Journal
JNCI Journal of the National Cancer Institute