Benefit and Tolerance to Induction Therapy in Elderly Patients with Locally Advanced NSCLC

Jenny Powers

doi:10.1177/155989771403006

Summary

Elderly patients with locally advanced non-small cell lung cancer (NSCLC) could present similar benefit and tolerance as their younger counterparts to induction chemotherapy (CT) or chemoradiotherapy (CRT) followed by either surgical resection or consolidation radiotherapy. The elderly population is growing and that half of lung cancers are diagnosed in patients older than 60 years [Gridelli C et al. Crit Rev Oncol Hematol 2002]. However, elderly patients are seldom included in multimodal programs of induction CT or CRT [Gridelli C et al. Crit Rev Oncol Hematol 2002].

Radiology
Cancer Clinical Trials
Respiratory Cancers

Radiology
Cancer
Oncology Clinical Trials
Oncology
Respiratory Cancers

Elderly patients with locally advanced non–small cell lung cancer (NSCLC) could present similar benefit and tolerance as their younger counterparts to induction chemotherapy (CT) or chemoradiotherapy (CRT) followed by either surgical resection or consolidation radiotherapy. Dr. Diego Márquez-Medina, University Hospital Arnau de Vilanova, Lleida, Spain, noted the conundrum that the elderly population is growing and that half of lung cancers are diagnosed in patients older than 60 years [Gridelli C et al. Crit Rev Oncol Hematol 2002]. However, elderly patients are seldom included in multimodal programs of induction CT or CRT [Gridelli C et al. Crit Rev Oncol Hematol 2002].

The Spanish investigators conducted a retrospective review of data from 108 consecutive patients with Eastern Cooperative Oncology Group status 0 to 2 locally advanced NSCLC who received induction CT or CRT plus surgery or consolidation radiotherapy, analyzing the feasibility, tolerability, and efficacy of these therapies in patients younger (59.2%) and older (40.7%) than 70 years. Elderly patients tended to present worse Eastern Cooperative Oncology Group scores (p=0.088) and stage IIIB NSCLC. The prevalence rates of squamous cell carcinomas, adenocarcinomas, and unspecified NSCLC were similar between the cohorts.

The CT regimens included platinum doublets with vinorelbine, gemcitabine, and taxanes. Carboplatin doublets were more commonly administered to the elderly patients (p=0.025).

Induction CRT and CT were administered to 59.3% and 40.7% of younger and 49.9% and 50.1% of older patients, respectively. Both age groups had similar radiologic responses. Pathologic responses after resection surgery were also similar between age groups, and no differences regarding overall survival and disease-free survival were found. Interestingly, grade 3 or 4 toxicity was more common among younger patients (p=0.053). No grade 3 or 4 pneumonitis was detected in either age group.

The investigators concluded that induction CT or CRT plus surgery or consolidation RT can be used in an elderly population. Elderly patients demonstrated treatment response and outcomes equivalent to those of younger patients.

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