Do elderly NSCLC stage IV patients benefit from chemotherapy as well as younger? An analysis from clinical practice date

Abstract

Aim: The aim of this study was to evaluate the efficacy of treatment related to age in metastatic non-small cell lung cancer (NSCLC). We compared young and elders (> 70) in the setting of a regional Spanish hospital. We hypothesized that elder benefit as much as younger patients from chemotherapy in stage IV NSCLC. The study was limited to performance status 0-2.

Methods: Clinical and demographic characteristics were reviewed form medical records. Type of treatment was collected and compared, as well as benefit from treatment, in terms of overall survival.

Results: 322 patients (162 young, 160 aged) Elderly patients received less active treatment (63% vs. 86%, P = 0.001). Elderly received less chemotherapy, less cisplatin-doublets, more carboplatin-combinations and monotherapy (P = 0.035). The benefits of treatment were similar, regardless of age. Smoking status demonstrated a prognosis impact for elder patients treated with chemotherapy. Those who remained active smokers had a lower overall survival in the aged group. In a multivariate analysis, the Eastern Cooperative Oncology Group, active treatment and non-smoking history were favorable prognostic factors for elder patients. Smoking had not impact on young patients.

Conclusion: Elderly patients were undertreated in clinical practice. Treatment showed similar overall survival despite of age. The impact of smoking seems to be more significant in the elderly population.

Keywords

Non-small cell lung cancer / elderly / chemotherapy / overall survival / smoking habits / platinum-combinations

References

[1] Alberg AJ,Ford JG,Spivack SD.Epidemiology of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines..Chest2013;143:e1S-29S

[2] Hurria A,Cohen HJ,deShazo M,Ganti AK,Holmes HM,Keating NL,Medeiros BC,O'Connor T,Rugo HS,Tew WP,Weir AB3rd.Senior adult oncology..J Natl Compr Canc Netw2012;10:162-209 PMCID:PMC3656650

[3] Sacher AG,Leighl NB.Elderly patients with advanced NSCLC in phase III clinical trials: are the elderly excluded from practice-changing trials in advanced NSCLC?.J Thorac Oncol2013;8:366-8

[4] Davidoff AJ,Seal B.Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer..J Clin Oncol2010;28:2191-7

[5] Beckett P,Tata LJ,Peake MD,Woolhouse I,Hubbard RB.Clinical management of older people with non-small cell lung cancer in England..Thorax2012;67:836-9

[6] Sim SH,Kim SH,Kim TM,Kim DW,Lee JS.Current status of chemotherapy use and clinical outcome in octogenarians with advanced non-small cell lung cancer..J Cancer Res Clin Oncol2015;14:1073-81

[7] Firat S,Byhardt RW.Age is independent of comorbidity influencing patient selection for combined modality therapy for treatment of stage III nonsmall cell lung cancer (NSCLC)..Am J Clin Oncol2006;29:252-7

[8] Wisnivesky JP.Treating elderly patients with stage III NSCLC..Lancet Oncol2012;13:650-1

[9] Wang S,Hamilton N,Jahan TM.Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans..J Clin Oncol2012;30:1447-55 PMCID:PMC3383118

[10] Blanco JAG,Alvarez RF,Gonzalvez AM.Age, comorbidity, treatment decision and prognosis in lung cancer..Age Ageing2008;37:715-8

[11] de Rijke JM,Velde ten GPM,Bollen EC,van Dijck JA,van den Brandt PA.Influence of age, comorbidity and performance status on the choice of treatment for patients with non-smallcell lung cancer; results of a population-based study..Lung Cancer2004;46:233-45

[12] Pallis AG,Wedding U,Veronesi G,Luciani A.Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC elderly task force, Lung Cancer Group and International Society for Geriatric Oncology..Ann Oncol2014;25:1270-83

[13] Weiss J.Treatment of lung cancer in the elderly patient..Semin Respir Crit Care Med2013;34:802-9

[14] D'Addario G,Leighl NB,Cerny T.Platinum-based versus non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a meta-analysis of the published literature..J Clin Oncol2005;23:2926-36

[15] Gridelli C,Shepherd FA,Piantedosi F,Manzione L,Frontini L,Findlay B,Myers R,Gebbia V,Fava S,Bezjak A,Perrone F.Gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non-small-cell lung cancer: a phase III trial of the Italian GEMVIN Investigators and the National Cancer Institute of Canada Clinical Trials Group..J Clin Oncol2003;21:3025-34

[16] Schiller JH,Belani CP,Sandler A,Zhu J.Comparison of four chemotherapy regimens for advanced non-small cell lung cancer..N Engl J Med2002;346:92-8

[17] Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer.The Elderly Lung Cancer Vinorelbine Italian Study Group..J Natl Cancer Inst1999;91:66-72

[18] Frasci G,Panza N,Nicolella G,De Cataldis G,Bilancia D,Massidda B,Comella G.Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer..J Clin Oncol2000;18:2529-36

[19] Gridelli C,Gallo C,Rossi A,Barbera S,Piazza E,Clerici M,Robbiati SF,Sacco C,Favaretto A,Migliorino MR,Galetta D,Gebbia V.Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial..J Natl Cancer Inst2003;95:362-72

[20] Kudoh S,Nakagawa K,Katakami N,Shinkai T,Goto I,Seto T,Satoh T,Negoro S.Phase III study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the West Japan Thoracic Oncology Group Trial (WJTOG 9904)..J Clin Oncol2006;24:3657-63

[21] Quoix E,Oster JP,Pichon E,Dauba J,Souquet PJ,Dansin E,Molinier O,Moro-Sibilot D,Bennouna J,Ducoloné A,Baudrin L,Milleron B.Intergroupe Francophone de Cancérologie Thoracique. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial..Lancet2011;378:1079-88

[22] Ettinger DS,Borghaei H,Cheney RT,National comprehensive cancer network.Non-small cell lung cancer, version 2, 2013..J Natl Compr Canc Netw2013;11:645-53

[23] Travis WD,Müller-Hermelink HK.Pathology and genetics of tumours of the lung, pleura, thymus and heart..Lyon: IARC Press:2004;

[24] Bach PB,Thornquist MD,Tate RC,Hsieh LJ.Variations in lung cancer risk among smokers..J Natl Cancer Inst2003;95:470-8

[25] Janssen-Heijnen ML.The changing epidemiology of lung cancer in Europe..Lung Cancer2003;41:245-58

[26] Alberg AJ,Samet JM.Epidemiology of lung cancer: looking to the future..J Clin Oncol2005;23:3175-85

[27] Thomas L,Edelman J.Lung cancer in women: emerging differences in epidemiology, biology and therapy..Chest2005;128:370-81

[28] Lortet-Tieulent J,Ferlay J,Weiderpass E.International trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women..Lung Cancer2014;84:13-22

[29] Suda K,Mizuuchi H,Kitahara H,Kohno M,Okamoto T,Yatabe Y.Genetic and prognostic differences of non-small cell lung cancer between elderly patients and younger counterparts..Aging Dis2012;3:438-43

[30] Zhang Y,Pan Y,Shen L,Luo X,Wang R,Li H,Pao W.Frequency of driver mutations in lung adenocarcinoma from female never-smokers varies with histologic subtypes and age at diagnosis..Clin Cancer Res2012;18:1947-53 PMCID:PMC3319848

[31] Regina Gironés Sarrió,Pedro López,Rafael Rosell.Smoking habits in elderly lung cancer patients: still no changes in epidemiology? A single-center experience..Clin Transl Oncol2010;12:686-91

[32] Meoni G,Lucherini E.Medical treatment of advanced non-small cell lung cancer in elderly patients: a review of the role of chemotherapy and targeted agents..J Geriatr Oncol2013;4:282-90

[33] Maione P,Sacco PC,Schettino C,Falanga M,Gridelli C.Treating advanced non-small cell lung cancer in the elderly..Ther Adv Med Oncol2010;2:251-60 PMCID:PMC3126022

[34] Gironés R,Gómez-Codina J,Tenias JM.Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores..Lung Cancer2011;72:108-13

[35] Regina Gironés,Inma Maestu,Jose M.Tenias, Rafael Rosell Costa . Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: a single-center experience..J Geriatr Oncol2012;3:98-103

[36] Froesch P,Györik S,Cafarotti S.Management of non-small cell lung cancer in the elderly..Eur J Intern Med2014;25:888-94

[37] Ramalingam SS,Langer CJ,Belani CP,Sandler AB,Johnson DH.Eastern Cooperative Oncology Group. Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: analysis of Eastern Cooperative Oncology Group Trial 4599..J Clin Oncol2008;26:60-5

[38] Alexa T,Luca A,Alexa ID.Incidence of chemotherapy discontinuation and characteristics of elderly patients with non-small cell lung cancer treated with platinum-based doublets..Contemp Oncol (Pozn)2014;18:340-3

[39] Gironés R,Gómez-Codina J,Tenias JM.Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians..Clin Transl Oncol2012;14:183-9