Nearly one-third of the estimated 144,000
patients who are diagnosed with non-small-cell lung cancer (NSCLC) in
the United States each year are over the age of 65 years. Elderly
patients often do not have access to the range of treatment options
available to younger patients. For instance, a study published late
last year found that younger patients with advanced NSCLC were three
times more likely to receive chemotherapy than were older patients.
Besides increased sensitivity to the side effects of platinum-based
chemotherapy, elderly patients often have other diseases, as well as
diminished physical resilience. Add poor survival prognosis for
advanced NSCLC to these factors and the result has been fewer
treatment options for elderly lung cancer patients.
Single-Agent Chemotherapy Effective in Elderly
An article in a recent issue of the Journal of the National Cancer Institute
offers elderly lung cancer patients a chemotherapy regimen that
reduces symptoms and treatment side effects and may prolong life. The
Elderly Lung Cancer Vinorelbine Italian Study Group (ELVIS) reports
on the first multicenter, randomized clinical trial examining
single-agent chemotherapy with vinorelbine (Navelbine) in elderly
lung cancer patients.
We feel the results of this trial show that treatment with
vinorelbine may be a valuable option for elderly non-small-cell lung
cancer patients. This is the first treatment option we discuss,
said principal researcher, Dr. Cesare Gridelli of the Instituto
Nazionali per la Studio e la Cura del Tumori in Naples, Italy. Dr.
Gridelli and his colleagues recommend that single-agent vinorelbine
become the control arm for future studies exploring chemotherapy in
elderly lung cancer patients.
The ELVIS study divided 161 patients over 70 years of age with
late-stage NCSLC into two arms. Patients in the chemotherapy arm
received vinorelbine, while those in the control arm received
supportive care only. Self-directed questionnaires measured
quality-of-life factors. Although the study was flawed by low
enrollment, results were encouraging enough to cause researchers to
begin administering vinorelbine to patients in the control arm before
the studys projected conclusion.
Besides finding improved quality of life, researchers discovered a
clear survival advantage for patients treated waith the vinorelbine
regimen compared to those in the control group. Nearly twice as many
patients on the vinorelbine arm were alive 1 year into the study.
Vinorelbine-treated patients also had fewer of the symptoms of lung
cancer, such as pain and shortness of breath. (Of the 78 patients in
the vinorelbine group, 5 were removed from the trial due to either
severe constipation or arrhythmia.)
Dr. James Rigas, director of thoracic oncology at the Norris Cotton
Cancer Center of Dartmouth-Hitchcock Medical Center in Lebanon, New
Hampshire, is encouraged by the ELVIS results. I am so happy to
see this study finally published. I think a lot of physicians were
already using vinorelbine for their elderly patients. They knew it
was gentler [than mixed-agent chemotherapy] but were unsure if it was
really helpful. The ELVIS study shows it increases survival time and
maintains good quality of life.
However, the perception that chemotherapy is exceedingly harsh
persists among many elderly patients, said Dr. Rigas. He hopes more
physicians will gain confidence about prescribing vinorelbine and
realize the value of getting to know each patient as a unique person.
I routinely tell elderly lung cancer patients we can help
you live longer, with fewer symptoms. Then I find out about
their life, what they want to live for, and we decide together
whats right for them.
Perspectives of Patients Treated With Vinorelbine
One of Dr. Rigas patients, 73-year-old June Charron of
Lyndonville, Vermont, has been living with lung cancer since 1995.
She has had two surgeries and two recurrences. When she learned that
cancer had returned to both lungs, she was leery of chemotherapy.
After consulting with Dr. Rigas, Ms. Charron began treatment with
mitomycin (Mutamycin) and vinorelbine but experienced low white blood
cell counts and switched to therapy with vinorelbine alone.
Its been over a year now and the cancer hasnt
progressed. I go through chills, then hot flashes the day of
treatment, once every 4 weeks, but after that I feel fine, she said.
Another of Dr. Rigas patients, David Moyer, 73 years old, of
Hanover, New Hampshire, began vinorelbine treatments last April,
after surgery was ruled out for a tumor in his right lung.
Im tolerating the Navelbine very well, he
commented. But first, I had a sizable conference with Dr.
Rigas. He said the side effects vary from individual to individual.
After that talk, I wasnt as apprehensive.
Mr. Moyer was fatigued during the first few courses of treatment, but
now feels well enough to walk over 2 miles a day. He regards
chemotherapy as a holding action. This is not going to cure it
but maybe it will hold it in check till they find something that
will, he said.
Advocacy Group Praises Study
Peggy McCarthy, executive director of the Alliance for Lung Cancer
Advocacy, Support and Education (ALCASE), praised the ELVIS report as
a breakthrough for elderly patients.
This is a very important study and shows that treatment with
single-agent chemotherapy is a valid option for elderly patients. We
hope this is only the first of many studies in the treatment of lung
cancer in the elderly, Ms. McCarthy said.
Based on our telephone calls, we know that a large number of
elderly patients are told by their diagnosing physician that there is
no medical care available for them. This study should be read by
every physician who diagnoses and treats lung cancer so that all
elderly patients are aware of their treatment options. Not only does
single-agent treatment show an acceptable level of side effects and
relief of disease-related symptoms, but it may allow older patients
to be alive for those moments that matter to thema
grandchilds wedding or great-nephews graduation.