Never Too Late for Therapy

Lung cancer patients who are physically fit can still benefit from treatment

(RxWiki News) Older lung cancer patients who have not responded to standard chemotherapy may be reluctant to continue treatment. Later-stage drug treatment, however, can be effective. Older patients often go under-treated because of concerns that they will not be able to tolerate certain toxic therapies.

A new study reports that older people respond as well as younger patients to so-called “salvage targeted therapy.”

This is the final treatment offered if other therapies have not been effective or tolerated.

Surprisingly, older men seem to have significant clinical benefit from certain agents used in this type of treatment. For example, elderly men aged 70 years or more treated with sorafenib had a higher overall survival compared with younger men.

"Later-stage cancer therapy works - ask an oncologist."

Anne Tsao, MD, oncologist and director of the Thoracic Chemo-Radiation Program at The University of Texas MD Anderson Cancer Center, Houston, Texas, led the study of 255 non-small cell lung cancer (NSCLC) patients.

More than 50 percent of lung cancer patients are diagnosed when they are over the age 65, and about 30 percent are over 70, according to a study from the Division of Medical Oncology, S.G. Moscati Hospital in Italy. More than two-thirds of patients who die from lung cancer in the US are over 65 years old.

Subjects in this study ranged in age from 26 to 84, and 38 percent were 65 or older. All the patients were from a larger study called the Biomarker-Integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) trial.

Patients were randomly put into groups and received one of four drugs— erlotinib (Tarceva), erlotinib-bexarotene (bexarotene brand name is Targretin), vandetanib (Caprelsa) or sorafenib (Nexavar).

Scientists compared outcomes of age groups 65 and older versus younger than 65, and 70 and older versus younger than 70.

After eight weeks, investigators found that there was no difference in overall response rate between any age group or sex. There was also no difference in progression-free survival between any of the overall age groups. Progression-free survival (PFS) is the length of time during which the disease does not get worse.

The authors pointed out that elderly men actually had an improved progression-free survival rate compared to younger men. The median PFS for men age 70 and older was 2.8 months compared with 1.8 months for younger men. The numbers were the same when comparing men age 65 and older with younger men. Dr. Tsao added that results should be "viewed with caution given the small numbers."

Researchers also highlighted that women age 70 and older in the group taking vandetanib experienced the opposite effect with their PFS at 1.1 months vs. 1.8 months for younger women.

No increased incidence of collapsed lung was noted in patients over 65, but the older subjects had more complaints of diarrhea and gastrointestinal problems.

"We know that oncologists often undertreat elderly patients due to concerns that they will not be able to tolerate therapy," said Dr. Tsao. "This study was important in demonstrating that elderly patients have equivalent outcomes to younger patients when treated with salvage targeted agents."

"It provides supportive evidence that elderly fit patients should enroll on clinical trials and should be treated aggressively. They can have the same benefit to treatment as younger patients. Our population is aging and we are seeing older oncology patients in greater numbers."

"The oncology community needs to reform the belief that fit elderly patients cannot be treated with equal and aggressive salvage therapy."

The study was published in the November issue of the International Association for the Study of Lung Cancer’s (IASLC) Journal of Thoracic Oncology.

Review Date: 
November 14, 2012