Elderly NSC lung cancer patients benefit from concurrent chemoradiation

By Andrew Czyzewski

Fit older adults with locally advanced non-small-cell lung cancer (LA-NSCLC) reap similar benefit from concurrent chemoradiation with etoposide and cisplatin (EP/XRT) as younger patients, but experience higher rates of hospitalization and toxicity, research shows.

Irrespective of age, consolidation docetaxel after EP/XRT did not improve survival in LA-NSCLC, report Shadia Jalal (Indiana University, Indianapolis, USA) and colleagues.

Clinical trials have demonstrated that concurrent chemoradiation with EP/XRT improves survival time compared with radiation alone or sequential chemotherapy and radiation, and this is considered the standard treatment for fit patients with inoperable stage III LA-NSCLC.

But older adults may have unique barriers preventing cancer treatment and participation in clinical trials. Low rates of participation of older adults in clinical trials limit the generalizability of the findings and have prompted the design of trials in elderly patients.

"Although the investigators should be credited for designing trials that improve the generalizabilty of the findings and for testing alternative regimens for those ineligible for definitive concurrent chemoradiation, elderly-specific trials risk perpetuating bias among clinicians against providing definitive therapy to older adults with good performance status and no comorbidity," Jalal et al comment.

The current study used data from the Hoosier Oncology Group LUN 01-24, which enrolled 243 patients with LA-NSCLC. In all, 166 patients treated with EP/XRT were randomly assigned to receive three cycles of docetaxel versus observation. Patients aged 70 years or older accounted for 26% of patients.

The median survival time (MST) for the overall study population was 21.5 months, and 3-, 4-, and 5-year survival rates were 30.7%, 18.0%, and 13.9%, respectively.

There was no significant difference in survival time based on patient age or receipt of consolidation docetaxel: MST for patients aged less than 70 years was 22.8 months compared with 17.1 months for those aged 70 years or older. Four- and 5-year survival rates for older compared with younger patients were 15% versus 19%, and 5% versus 19%, respectively.

However, older adults did experience higher rates of hospitalization, grade 3-4 toxicity, and treatment discontinuation due to toxicity. Unlike in previous studies, however, older patients did not have higher rates of esophagitis and pneumonitis than younger patients.

Neither older nor younger patients experienced a survival benefit from consolidation docetaxel.

"Many other factors, such as limited mobility (recent falls), limited social support, and impaired performance of instrumental activities of daily living, contribute to the burden of symptoms experienced by a patient, therefore, treatment decisions for older adults must be individualized," Jalal et al conclude in the Annals of Oncology.

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