PHILADELPHIAFit, elderly patients with nonsmall-cell lung
cancer (NSCLC) can handle platinum-based therapy as well as younger
patients, according to a secondary analysis of data from Eastern
Cooperative Oncology Group (ECOG) study 5592. Corey Langer, MD, of
Fox Chase Cancer Center, presented the analysis at the ASCO annual
There is a bias against treating older people as vigorously with
chemotherapy as younger patients are treated, Dr. Langer observed.
Advanced age alone, however, does not equate with poor performance
status (PS), he said, and should not preclude patients from receiving
appropriate therapy for their disease.
To settle the issue, Dr. Langer spearheaded an analysis of outcomes
in ECOG 5592 using age 70 as the cutpoint. ECOG 5592 was a phase III
study in which patients with stage III-IV NSCLC received a fixed dose
of platinum (75 mg/m²) combined with either etoposide 100
mg/m² IV on days 1 to 3, paclitaxel (Taxol) 135 mg/m² over
24 hours, or paclitaxel 250 mg/m² over 24 hours plus G-CSF
The study population involved 488 patients younger than age 70 and 86
patients aged 70 and above. The secondary analysis found response
rate, time to progression, and median survival to be essentially
equivalent between the age groups. One-year survival was numerically
higher for younger patients (38% vs 28%), as was 2-year survival
(13.5% vs 11.6%), but these differences were not statistically
significant, he reported.
The equivalency in outcomes was interesting in light of the fact that
older patients had worse pretreatment characteristics. They generally
had more cardiovascular and respiratory comorbidities and were taking
more medications. This led to more treatment-related toxicity in the
older group, including more severe leukopenia, more deaths from
febrile neutropenia, and more neuropsychiatric toxicity.
Older patients, however, rated their quality of life similarly to
younger patients, Dr. Langer reported.
PS Status Matters
David Gandara, MD, of the University of California, Davis, serving as
discussant at the session, commented: The question of whether
the elderly represents a poor-risk group is a critical one.
Although relatively few elderly are entered into clinical trials, he
said, the US Cooperative Group database on NSCLC suggests that the
fit elderly fare well with standard treatment approaches,
as Dr. Langers analysis showed.
Poor risk can then be defined as PS 2, with or without low
albumin or weight loss or comorbid conditions. A greater proportion
of the elderly do fall into this poor-risk category, Dr.
Further, he said, PS 2 patients are the ones who do poorly with
the aggressive new-agent/platinum regimens. New trials from SWOG and
ECOG, will focus on assessing the tolerability and benefits in
poor-risk patients independent of age.