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

Smoking had an important impact on elderly patients
1.0
treated.
Smoking habbit
0.8 Active smoker Elderly patients tended to have poorer PS. All of
Ex-smoker the elderly women except one were never smokers.

0.6 With the increasing number of female smokers, it is
uncertain whether in the future we will see greater
numbers of elderly women smokers. [24-27] Most
0.4
probably, due to the high sensitivity of women to
tobacco carcinogens, the tendency will be towards an
0.2 increase of younger female lung cancer patients. [28]
In any case, never smoker status was significantly
0.0 related to EGFR-mutation in elderly and younger
women. A higher prevalence of EGFR mutations in
0 10 20 30 40
[29]
Survival in months the elderly has already been described, and, as in
our series, older age at diagnosis has been reported
Figure 6: Differences in overall survival by smoking status in elderly
patients treated with chemotherapy to be an independent predictor of EGFR mutations in
female never-smokers with adenocarcinoma. In this
[30]
platinum-combinations vs. monotherapy, the same study, in males never smokers, smoking habit was
benefit was found for younger versus elderly patients related to EGFR mutation in the elderly group only;
(P = 0.14). Platinum-combinations were found to be it was not a predictor of EGFR status in the younger
more effective in younger patients (9.5 vs. 5.7 months; group. Smoking was related to histology in the elderly;
platinum vs. non-platinum combinations respectively), squamous cell lung carcinoma was the main histology
but no differences were found in the elderly group (10.5 in this group. Adenocarcinoma related to smoking was
vs. 10.2 months; combination vs. monotherapy). Few more predominant in the younger group. It should be
patients were treated with bevacizumab and we are taken into account that the elderly patients were mostly
therefore unable to draw conclusions. No differences ex-smokers. The high incidence of smoking history in
in survival were found with respect to distinct platinum the elderly has already been described. [31]
combinations.
Most elderly patients with metastatic NSCLC do not
Smoking habit had impact on overall survival in elderly receive chemotherapy, as database analyses have
patients that received chemotherapy (P = 0.006) shown. In our series, elderly patients were less
[4]
[Figure 6]. Median overall survival for active smokers likely to receive chemotherapy than younger patients;
during chemotherapy treatment was 6.5 (95% CI 3.9- however on analysis of those elderly patients suitable
9.1) vs. 12.1 months (95% CI 9.5-14.7), P = 0.011 for for chemotherapy, almost 85% received chemotherapy.
those who had quit smoking. In addition, smoking had This is a probably a higher rate of treatment than
an impact on the outcomes of patients who received reported in published data. For example, one analysis
[34]
combination therapy in the elderly group; smokers performed by SEER-Medicare, which considered
[4]
treated with platinum-combination had median overall elderly patients as those > 66 years, showed that
survival of 6.9 months (95% CI 4.1-9.6) vs. 12.7 only 25.8% received first-line chemotherapy. In
months in ex-smokers (95% CI 9.4-15.9. Median that study, multivariate analyses indicated that with
overall survival for patients receiving monotherapy in increasing age, comorbidity and poor PS, treatment
the elderly group was 6.8 months for active smokers with any chemotherapy and platinum-based doublet
(95% CI 3.2-13.1) vs. 10.8 months in ex-smokers (95% regimens is less likely to be used. In our series, the
CI 6.4-15.1) (P = 0.014). The relationship between elderly patients were older than those in the SEER
smoking status and chemotherapy was not significant analysis (> 70). From a total of 160 elderly patients,
in the younger group. 71 (44.3%) received chemotherapy. This is a higher
figure than reported in other studies. Platinum-doublet
DISCUSSION chemotherapy regimens have been shown to extend
survival in fit patients with advanced non-small-cell lung
In this study, we analyzed all elderly patients with cancer. At our study, both, cytotoxic chemotherapy
[4]
advanced NSCLC who visited our outpatient hospital and EGFR TKI treatments are feasible and prolong
over a 10-year period, and found that 64% (n = 102) survival when comparisons are made with patients
received active treatment. The elderly patients treated who do not receive chemotherapy in both groups. It
benefit in a similar way that younger counterparts. seems that the benefit of treatment of elderly patients
384 Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ September 30, 2016