Finding runs counter to expert recommendations against use of the therapy by those over 70
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MONDAY, Aug. 8 (HealthDay News) -- Countering conventional wisdom, researchers in France say that elderly lung cancer patients can gain significant benefit from an aggressive, double-barreled chemotherapy that's often used in younger patients.
The finding raises questions about standard public health recommendations, such as those issued the American Society of Clinical Oncology in 2004, which advised physicians not to expose elderly patients with non-small cell lung cancer (NSCLC) to the undesirable side effects of combination chemotherapy.
Instead, older patients have typically been offered less harsh -- but also less effective -- chemotherapies containing a single agent. That's because, until now, it's been assumed that the benefits to elderly patients of dual-chemo ('doublet') regimens simply weren't worth their onerous side effects and risks.
But, 'our study demonstrates clearly that [the doublet] scheme is feasible in elderly patients,' study author Dr. Elisabeth Quoix, from the department of chest diseases at Hopitaux Universitaires de Strasbourg at the University of Strasbourg. She noted that survival rates among elderly patients, even among those over the age of 80, appeared comparable to those of younger patients on the dual-drug regimen.
The findings are reported online Aug. 9 in The Lancet.
As life expectancy increases, so does the risk for lung cancer, the leading cancer killer worldwide. As a result, studies show that lung cancer rates have been ramping up among the elderly, with patients in the developed world now averaging between 63 and 70 years of age at diagnosis.
According to Quoix, that means that 'elderly patients represent around 50 percent of all patients with lung cancer.' She also believes that 'there has been for quite a long time such a nihilism toward this disease, especially for elderly patients, that unfortunately most of these patients are under-treated.'
In fact, prior research indicates that, in recent years, as little as one-quarter of NSCLC patients over the age of 66 have gotten the same first-line standard of care as younger patients.
To learn more, between 2006 and 2009 Quoix' team recruited just over 450 NSCLC patients between the ages of 70 and 89. All of these patients were undergoing treatment at one of 61 different medical centers across France.
Half were placed on a dual-chemotherapy regimen involving the agents carboplatin and paclitaxel, which together comprise what doctors call 'platinum-based doublet chemotherapy.' The other half were placed on a single drug ('monotherapy') regimen involving either vinorelbine or gemcitabine.
Dual-regimens were spread across four weeks, while the single regimens were spaced over three weeks.
The researchers found that toxic side effects were indeed more common among those exposed to two chemotherapy agents at once. Yet over the course of 2.5 years of follow-up (on average), the team also found that survival rates were much higher among the dual-chemo group.
For example, elderly patients who were placed on the two-drug therapy survived more than 10 months on average, compared with just over 6 months for those getting the single therapy group.
What's more, nearly 45 percent of doublet patients survived to the one-year mark post-treatment, compared with about 25 percent of those in the single-chemo group.
The authors concluded that -- harsher toxic side-effects notwithstanding -- double-chemo treatment appears to afford elderly lung cancer appreciable and worthwhile benefits. They therefore called for a reconsideration of current protocols for lung cancer treatment among the elderly.
However, in an editorial, Dr. Karen L Reckamp, from the City of Hope Comprehensive Cancer Center in Duarte, Calif., said that there have been too few clinical trials involving older men and women with lung cancer. That means that the 'optimum chemotherapy regimen remains unknown' for elderly lung cancer patients, she wrote.
'Clinical trials that examine therapy for lung cancer usually include a minority of patients over 70, so that results do not provide guidance on the best treatment for this group,' Reckamp explained.
But she agreed that the new French study 'moves the field forward' by highlighting the apparent 'dramatic improvement in survival' among elderly afforded dual-chemo treatment.
'This strongly supports doublet chemotherapy in carefully selected older individuals with NSCLC,' Reckamp said. However, 'the results must be balanced by a look at the increased toxicities and deaths in the combination arm. We are still in need of addition studies that evaluate older individuals with NSCLC and perform an assessment so that we might predict those who may have greater benefit or who might be at greater risk for toxicity.'
SOURCES: Elisabeth Quoix, M.D., department of chest diseases, Hopitaux Universitaires de Strasbourg, University of Strasbourg, France; Karen L Reckamp, M.D., City of Hope Comprehensive Cancer Center, Duarte, Calif; Aug. 9, 2011, Lancet, online
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