Chemotherapy not Effective in Seniors?

Non small cell lung cancer treatment with bevacizumab ineffective in elderly

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Cancer treatment has come a long way in the last few decades, and further refinement is a constant process. New research shows that the age of the patient may influence the best drug treatment option.

A drug trial examining the effectiveness of chemotherapy in different groups of patients found that those over 65 did not benefit from the addition of the drug Avastin (bevacizumab).

"Ask your oncologist about new cancer research."

Researchers from the Dana Farber Institute examining chemotherapy modification for advanced cases of non small cell lung cancer concluded that adding Avastin did not change survival rates in patients older than 65.

The study was a retrospective analysis, with 366 patients falling in the group of 65+. Difference in median survival was 9.7 months if Avastin was added to the standard chemotherapy of carboplatin and paclitaxel in comparison to 8.9 months without Avastin.

After adjusting the data to minimize confounding variables and account for selection bias, researchers concluded that the difference fell under normal statistical variability and was not significant.

While Avastin was initially approved for non small cell lung cancers, this research is an especially important finding because the majority of patients who are diagnosed with non small cell lung cancer are both over 65 and have an advanced cancer staging of III or higher.

The conclusion from this research is that adding Avastin to the majority of patients with non small cell lung cancer is not beneficial, an important footnote to an expensive treatment.

Research used the government database SEER (Surveillance, Epidemiology, and End Results), which is published and collected by the National Cancer Institute, for their analysis.

After initially failing to find a statistically significant difference in the results, five different statistical methods were used to examine the data independently.

"Despite the longer survival with the 3-drug combination therapy, the differences were not statistically significant when the researchers adjusted the data to "minimize confounding and selection bias," said Deborah Schrag, MD, study author. "No matter what we did, our finding held."

Some controversy has come forth on this subject because of a perception that real-world statistics fall short of data from clinical trials used to lobby for FDA approval on several drugs.

Genetech, the drug's manufacturer, released a press statement stating that sub-optimum treatment success is to be expected in the oldest group of patients, especially considering the likelihood of more advanced stages of cancer.

Genetech argues that Avastin should still be considered an advancement and considered for inclusion in treatment of older patients with advanced disease as it is proven to lengthen median survival.

Study authors, in turn, argued that clinical drug trials should include more patients that accurately represent the patient population in the real world.

The study was published in the April 18 edition of the Journal of the American Medical Association.

Funding for this effectiveness study was provided by the Agency for Healthcare Research and Quality and the National Cancer Institute. 

Reviewed by: 
Review Date: 
April 21, 2012
Last Updated:
April 22, 2012