Treatment of Older Patients With Non-Small-Cell Lung Cancer: Walking the Therapeutic Tightrope (original) (raw)
Related papers
Chemotherapy Options for the Elderly Patient with Advanced Non-Small Cell Lung Cancer
The Oncologist, 2003
Learning Objectives After completing this course, the reader will be able to: Describe the available clinical trial data of chemotherapy for advanced non-small cell lung cancer in elderly patients. Compare older chemotherapy combinations with newer single agents in the treatment of advanced non-small cell lung cancer. Identify reasons why elderly patients with lung cancer have been excluded from clinical trials. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Combination chemotherapy has been shown to improve overall survival compared with best supportive care in patients with advanced non-small cell lung cancer (NSCLC). The survival advantage is modest and was initially demonstrated with cisplatin-containing regimens in a large meta-analysis of randomized trials reported in 1995. Newer chemotherapy combinations have been shown to be better tolerated than older cisplatin-based combinations, and some trials have also show...
2015
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 pa-tients. We compared the effectiveness and toxicity of the combination of vinorelbine plus gemcitabine with those of each drug given alone in an open-label, randomized phase III trial in elderly patients with advanced NSCLC. Methods: Patients aged 70 years and older, enrolled between Decem-ber 1997 and November 2000, were randomly assigned to receive intravenous vinorelbine (30 mg/m2 of body surface area), gemcitabine (1200 mg/m2), or vinorelbine (25 mg/m2) plus gemcitabine (1000 mg/m2). All treatments were deliv-ered on days 1 and 8 every 3 weeks for a maximum of six cycles. The primary endpoint was survival. Survival curves
The Aged Patient with Lung Cancer
Drugs & Aging, 1994
1. Epidemiological Considerations 1.1 Is an Early Diagnosis Programme Justified in Elderly Patients? 2. Treatment 2.1 Surgery 2.2 Radiotherapy 2.3 Combined Radiotherapy and Chemotherapy 2.4 Chemotherapy 3. Conclusions Elderly patients with lung cancer have not benefited from the therapeutic improvements obtained during the 1980s with younger adults. Potentially operable non-small-cell lung cancers are more common in elderly patients, who are more likely to have localised disease at diagnosis. Even so, elderly patients are rarely treated with surgery. Radiotherapy remains the most frequently adopted tool to treat non-small-cell lung cancer in this age group. Epipodophyllotoxin derivatives constitute the best option for chemotherapy of elderly patients with small-cell lung cancer. When used as single agent regimens, these drugs show the same overall response rate as combination chemotherapy, but with reduced toxicity. Haematopoietic growth factors are used to reduce bone marrow damage following cytotoxic chemotherapy, and may be a promising tool in elderly patients. Special attention should be given to increasing the number of elderly patients with small-cell lung cancer enrolled in phase I and II studies to investigate new agents for the treatment of this tumour.
Treatment Approaches in 102 Elderly Patients With Non-Small Cell Lung Cancer
World Journal of Oncology, 2015
Background: The life expectancy and presence of co-morbidities cause reservations in treatment decisions for elderly patients with cancer. In this study, we retrospectively evaluated 102 patients who are considered as middle-old aged (aged 75-84) by gerontologists. Methods: Medical records of patients were reviewed. One hundred and two patients with a diagnosis of non-small cell lung cancer (NSCLC) whose follow-up ended with death between March 2006 and May 2013 were examined. Results: The median age at diagnosis was 77 (75-85) years. Thirtythree patients (67.6%) were over 80 years old. The number of patients with metastasis was 57 (55.8%). Forty-two (41.2%) patients had stage IIIA and IIIB disease. Fifteen of the metastatic patients (26.3%) were given chemotherapy, while 12 of the non-metastatic patients (26.6%) were given chemotherapy. Of the non-metastatic patients, 25 (55.6%) were treated with radiotherapy, and five (11.1%) were treated with chemotherapy. The median duration of follow-up was 4 (1-55) months. Progression-free survival (PFS) was 4 months in non-metastatic patients, and 3 months in metastatic patients. Overall survival (OS) was 4 months. OS rates for 1 and 2 years were 10% and 2%. Conclusion: Chemotherapy and radiotherapy may be administered even to patients of this age group. The beneficial effect of chemotherapy in patients with metastasis on OS is an important finding of our study.
Undertreatment of elderly patients with non-small-cell lung cancer
Clinical lung cancer, 2005
The absolute number of patients with lung cancer is rising as a result of our aging population. Until recently, clinicians have been reluctant to aggressively treat elderly patients with non-small-cell lung cancer (NSCLC) because of a lack of supportive data and concern for potential toxicity. Recently, evidence has emerged that suggests that, similar to younger patients, healthy elderly patients can benefit from therapy in all stages of NSCLC. This review will discuss the findings that indicate that chronologic age alone should not be a barrier to appropriate treatment for NSCLC, but consideration should be given to more important prognostic factors such as comorbidities and performance status.
Treatment of Non–Small Cell Lung Cancer in the Older Patient
Journal of the National Comprehensive Cancer Network, 2012
Lung cancer is a disease of the elderly, with a median age at diagnosis of 70 years. However, there is a dearth of good quality evidence to guide treatment in this population and most of the data are extrapolated from younger patients. Current research is directed toward establishing simplified instruments to quantify fitness of older patients for various forms of therapy. Although current evidence suggests that outcomes after standard therapy are similar to those seen in younger patients, older patients have an increased incidence of adverse events. Until better predictive markers are available to guide treatment, therapy should be individualized using available instruments, including a comprehensive geriatric assessment. If an older patient is deemed to be fit, it is reasonable to use the treatment options recommended for younger individuals. This article summarizes the available data on the treatment of non-small cell lung cancer in the older patient.
Chemotherapy for elderly patients with advanced non-small cell lung cancer in Tunisia
Journal of Geriatric Oncology, 2012
Objectives: First objective was better understanding of the indications of chemotherapy in elderly with advanced cancer, tolerability and toxicity of chemotherapy in this age group. The second objective was to defi ne current practice in chemotherapy for elderly people with advanced cancer for a selected group of patients treated in Institute of Oncology Bucharest (IOB). Materials and Methods: The study makes a clinical analysis of medical records of 27 patients from the archive of Institute of Oncology Bucharest treated by the same doctor. Patients were selected according to: age ≥ 65 years, ECOG performance status 0-1, normal blood counts and blood biochemistry, histological confi rmation of the diagnosis of cancer, patients should received at least 3 cycles of chemotherapy. We extract characteristics of the patients to see if they were a homogeneous group of patients and to compare them with data from the literature. Overall survival was calculated by the Kaplan Meyer curve. Results: 295 patients more then 65 years were treated in our site in 2 years 2011, 2012. 93 patients received chemotherapy and only 27 patients were enrolled in this study following inclusion criteria. Common sites of cancer were lung and breast. The most used cytostatics for lung cancer was gemcitabine and carboplatine and cyclophosphamide, metotrexat and 5 fl uorouracil for breast cancer. Toxicity was mild with the prevalence of hematologic toxicity. Overall survival without taking into account the type of cancer was 27.7 month. Conclusions: For selected patients, chemotherapy was well tolerated and appears to prolong survival regardless of the location of cancer. The relatively small number of elderly patients who received chemotherapy is probably due to lack of compliance to treatment, the increased number of co-morbidities and evaluation of performance status only by the ECOG index known not to be good enough to establish the indication of chemotherapy.