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Gironés et al. Age-related efficacy of treatment in metastatic NSCLC

INTRODUCTION chemotherapy, the actual proportion of patients who
receive chemotherapy, the actual treatment they
Lung cancer remains the most frequent cause of received and clinical outcome in these patients.
cancer-related death worldwide. Elderly patients
[1]
make up a substantial proportion of non-small cell METHODS
lung cancer (NSCLC) patients and their numbers are
expected to increase. They’ve been significantly We collected on a prospective manner of all patients
[2]
underrepresented in clinical trials, making it difficult with advanced NSCLC (stage IV) seen at the
to extrapolate clinical trial data. Despite the clear Regional Medical Oncology Unit form the Hospital
[3]
benefits to survival, most elderly patients with Lluis Alcanyis, Xàtiva since January 2004, creating a
advanced NSCLC are under-treated or do not receive data base register. Patients collected for this analysis
chemotherapy. [4,5] In general there is an expectation accomplished the following conditions: histological
that elderly patients have poor tolerance to treatment. or cytological confirmation of NSCLC (although we
[6]
Physicians may be reluctant to offer treatment accepted radiological diagnosis without histological
known to provoke troublesome side effects due to confirmation) in stage IIIB (pleural effusion, prior TNM
the unwarranted assumption that elderly patients do stage), or stage IV of the disease. Outpatient and
not benefit from cytotoxic therapy. [7,8] Consequently, those are suitable for treatment (PS 0-2). We collected
elderly patients are frequently under-treated, and data on baseline demographics, clinical characteristics
only one quarter of elderly patients (> 65 years) with and a detailed treatment history. Our study period
advanced NSCLC are reported to receive palliative covers January 2004 until December 2014. Tumor
chemotherapy. [4,9] Advanced age has been a prevalent histology was classified on the basis of the 2004 WHO
reason for not administering treatment, contrary to classification. Patients were classified respect to
[23]
established guidelines. [10-12] smoking habits into 3 groups: never smoker, active
smoker and ex-smoker (if they had quit smoking
Platinum-based doublet chemotherapy is considered a year or more prior to diagnosis). Data on drug-
to be standard of care for elderly patients with an sensitive epidermal growth factor receptor (EGFR)
Eastern Cooperative Oncology Group Performance mutations was collected, since June 1 2010 using
Status (ECOG PS) score of 0-1. [13-14] The association peptide nucleic acid-locked nucleic acid polymerase
of a platinum compound with a third-generation chain reaction clamp-based testing. When testing was
agent improves survival, [15-16] and seems to be the not performed the data was recorded as “unknown”.
most effective therapeutic choice in such cases. Anaplastic lymphoma kinase (ALK) translocations
Recently, several elderly-specific trials showed that have been determined via fluorescence in situ
chemotherapy is effective and feasible for elderly hybridization since June 2012. Studies of K-RAS
patients with NSCLC. [17-21] National Comprehensive mutation are not performed as part of standard care.
Cancer Network guidelines recommend platinum- For surviving patients, final follow up was recorded on
doublet chemotherapy in patients with good 15th December 2014. Survival time was calculated
performance status regardless of age. The European from the time of diagnosis until death or final follow up.
[22]
Organization for Research and Treatment of Cancer/
International Society for Geriatric Oncology also Statistical evaluation was performed using SPSS
recommend the use of carboplatin-based doublets version 20.0 software; unpaired Student’s t-test, Chi-
in fit elderly patients and single-agent treatment for squared, and Fischer exact test were used according
less fit patients. Despite recent developments in to data type. Statistical significance was defined as P <
[12]
treatment recommendations for elderly patients, little is 0.05; variables were considered to be independent for
known about use of these in clinical practice, and very the statistical analysis; continuous data was expressed
limited data are available for elderly patients outside as mean ± standard error. Statistical analyses of
of clinical trials. Limited data exist regarding real- categorical variables were performed using Pearson’s
world treatment patterns and outcomes with respect Chi-square test or Fisher’s exact test as appropriate.
to patients with metastatic NSCLC treated at Spanish Survival analysis was performed using the Kaplan-
regional hospitals. Meier method, and groups were compared using the
log-rank test. Univariate and multivariate analyses
We hypothesized that elder benefit as younger patients were performed using the Cox proportional hazard
from chemotherapy in stage IV NSCLC. Therefore, regression analysis.
in this study, we aimed to evaluate the proportion of
elderly advanced NSCLC patients attended at clinical The institution’s ethical review board approved the
practice who are candidates for standard systemic data base on 2004. Also it approved the review of
380 Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ September 30, 2016