Contrary to popular belief, patients over the age of 75 with acute myelogenous leukemia (AML) do just as well as younger patients with similar chemotherapy regimens. A new study published June 7, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, indicates that age cutoffs by themselves are not appropriate selection tools in treatment decision-making for AML. The full study will be available via Wiley InterScience, and will be published in the July 15, 2004 print issue.
AML, a common cancer in people over 60 years old, remains a poorly treated disease with three-year survival rates of less than 10 percent. The poor outcome from the disease has been attributed both to the veracity of the tumor itself, which depends largely on its genetics, and comorbidities that further diminish the patient's own functional reserve. While induction chemotherapy has been shown to benefit patients under 75, a common yet unsubstantiated belief pervades the practice of oncology that patients over 75 will not benefit from definitive treatment. Consequently, these elderly patients are often offered only palliative care. A team of investigators led by Dr. Norbert Vey of the Department of Hematology at the Institut Paoli-Calmettes in Marseille, France compared the outcome of 110 patients over 75 with 200 patients between the ages of 65-74 treated with similar protocols of chemotherapy.
The study found complete remission (CR) rates and two-year survival rates were similar between the two age groups when treated similarly. The most common treatment protocol, anthracyclin-based induction chemotherapy, resulted in CR rates of 45 percent in the patients over 75 and 49 percent in the patients aged 65-74. Two-year survival with this therapy was also similar at 27 percent in patients over 75 and 25 percent in patients aged 65-74.
According to analysis, the best predictor of survival was not age, but treatment protocol received (i.e. anthracyclin- based induction versus antimetabolite-based treatments). Moreover, achieving CR resulted in longer survival regardless of age.
The authors conclude that the data "indicates that selected patients aged >75 may benefit from intensive approaches to the same extent than less old patients."