Chemotherapy strategy for elderly lung cancer patients questioned
French scientists have suggested that elderly patients with non-small-cell lung cancer (NSCLC) may benefit from a two-drug chemotherapy combination usually reserved for younger patients.
But Cancer Research UK cautioned that the result should be confirmed in larger studies before this type of treatment can be widely adopted for older patients.
In research published in The Lancet, a team from the Hopitaux Universitaires de Strasbourg and Universite de Strasbourg concluded that patients over 70, who were treated with a two-drug platinum-based chemotherapy survived longer compared with those given a single drug therapy.
The team saw more side effects in the group of 225 elderly NSCLC patients treated with both carboplatin and paclitaxel than in the control group of 226 similarly aged participants given either vinorelbine or gemcitabine.
But despite this, those given the combination chemotherapy survived around four months longer on average than patients given just one drug (10.3 months versus 6.2 months). Forty-five per cent of patients given two drugs survived for one year, compared with 25 per cent of those given a single drug.
Patients aged over 70 with advanced NSCLC are usually given single-drug therapy, whereas younger patients - who are considered fitter - tend to be given two drugs. The authors point to concerns from clinicians, the patients and their families about side effects and the relevance of the treatment as reasons for this difference.
The team, led by Professor Elisabeth Quoix from the Department of Chest Diseases, writes: "Clinical trials with no upper limit of age suggested that fit elderly patients might gain similar benefits to their younger counterparts from platinum-based doublet chemotherapy.
"We believe that treatment current paradigm for elderly patients with advanced non-small-cell lung cancer should be reconsidered."
The most common side effects were a reduced white blood cell count (48 per cent of the two-drug therapy group versus 12 per cent of the one-drug therapy) and feelings of weakness (10 per cent versus six per cent).
Commenting on the research, also in The Lancet, Dr Karen L Reckamp, City of Hope Comprehensive Cancer Center in the USA, writes: "Older patients dominate the lung cancer population, but continue to be under-represented in clinical trials.
"Additional studies are needed that enrol adequate numbers of older adults, and include a comprehensive geriatric assessment to provide the knowledge required to properly assess the risk-benefit ratio in treatment decisions, so that a personalised approach can be taken."
Liz Woolf, head of Cancer Research UK's patient information website CancerHelp UK, said: "This study confirms that treatment for cancer needs to be tailored to the needs of the individual. In the 21st century, age is not necessarily a good indicator of fitness, and older people should not be denied appropriate treatment simply because of their age.
"When confirmed in larger studies, the results of this trial should help to dispel any prejudice that remains towards treatment choices for older people with cancer."
Copyright Press Association 2011