Combined treatment benefits elderly patients with lung cancer

Most elderly patients do not receive combined modality treatment (CMT) with both chemotherapy and radiation for locally advanced, non-small cell lung cancer (NSCLC) despite trial data indicating that CMT enhances survival, decreases comorbidities, and is potentially curative. Data presented by Martin J. Edelman, MD, professor of medicine, University of Maryland Greenebaum Cancer Center, Baltimore, indicate that elderly patients receiving chemotherapy followed by concurrent chemotherapy and radiation derive the most significant survival benefit.

Advanced age is independently associated with reduced use of CMT and although this may reflect patients' poor performance status, preference, or existing comorbidities, it may also reflect physician bias not to treat the fit elderly, reported Dr Edelman.

There are 30,000 to 40,000 new cases of NSCLC in elderly patients annually and for nonresectable cases, radiation was the only recommended treatment through the 1990s. The Cancer and Leukemia Group B (CALGB) protocol 390 demonstrated that induction chemotherapy before radiation did not benefit the population overall but may be useful in patients with weight loss, in those with poor performance status, and in elderly patients. Platinum-based chemotherapy is often not used in elderly patients because of toxicity concerns, but CALGB protocol 9730 demonstrated a benefit for elderly patients, Dr Edelman said.

Dr Edelman and colleagues analyzed SEER data for 6,325 patients with NSCLC who were aged 65 years or older and who had not undergone resection between 1997 and 2002. The investigators evaluated the patients' Medicare claims treatment data. Some treatment was initiated within 90 days of diagnosis in 66.8% of patients, but fewer than 60% of patients had chemotherapy at any time and only 45% received CMT.

Of the elderly patients who received CMT, 81% received concurrent chemotherapy and radiation. Platinum regimens accounted for 81% of the chemotherapy administered overall and for 75%, 90%, and 82% of patients receiving chemotherapy only, sequential chemotherapy and radiation, and concurrent treatment, respectively.

CMT enhanced survival compared with radiation alone (HR=0.772; P<.001). Survival was similar for those receiving sequential chemotherapy and radiation and for those receiving concurrent treatment. Patients receiving induction chemotherapy followed by concurrent therapy had the lowest hazard of death (HR=0.727; P<.0001), Dr Edelman said. Platinum doublet therapy was also associated with a reduced risk of death (HR=0.772; P=.004).