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

is similar (indeed a little better) to those obtained by effectiveness of treatment.
their younger counterparts.
The same prognostic factors were found for in the elder
Doublet platinum-based chemotherapy regimens and younger patients; PS 0-1, active treatment, never
are the standard of care for both adult and elderly smoker and EGFR mutation, regardless of age. For
fit advanced NSCLC patients, with good tolerance elderly patients, smoking has impact on benefit from
and only minor effects on quality of life (QoL). [32,33] In chemotherapy, as ex-smokers benefit more from both
our study, a high percentage of elderly patients with combination and monotherapy.
PS 0-1 suitable for chemotherapy did in fact receive
chemotherapy. Since 2006 we have used geriatric Our analysis raises several questions that deserve
assessments to determine suitability for treatment. [34,35] future study. In particular, we have noted that despite
All young patients with good PS were treated; but there gains in treatment rates during the study period, overall
were no differences in overall survival for those elderly. survival remains poor and smoking continues to be
Are elderly patients undertreated? Or are younger a major factor in determinant treatment outcomes,
patients overtreated? although only for the elderly. Our survival results
indicate that appropriate patients, regardless of age,
The elderly were less likely to receive cisplatin- can benefit from aggressive treatment. Additional work
combinations and more likely to receive monotherapy. on smoking is need to further elucidate the role of
Surprisingly we did not find any differences when smoking on age and treatment outcomes.
comparing platinum-combinations to monotherapy.
Monotherapy has been for several years the Our study has several limitations. First, this analysis
recommended palliative treatment for elderly patients was conducted in a single center, so we cannot
with advanced NSCLC. Factors that influence extrapolate our results the overall population with lung
[36]
whether a patient receives a platinum-doublet or cancer. Secondly, we have an important selection
single-agent are unclear in the elderly. Over the bias, as we only collected data on ambulatory patients.
period of study we have found a tendency to prescribe However, these are the patients that benefit most from
monotherapy, probably due to doubts about the benefit chemotherapy. Thirdly, some variables have not been
of platinum-combination until recently. Probably, these collected (median number of chemotherapy cycles,
elder patients were more carefully selected, and we chemotherapy lines, and progression-free survival).
do not know whether they would have benefited from Also, EGFR mutation test and ALK rearrangement
a platinum-combination. Other authors found that tests were not fully performed in most patients.
platinum-doublet chemotherapy provides greater
benefits than single agents in the elderly. [4] However, this study also has strengths. All data was
collected from the same oncology unit, and patients
It is difficult to make conclusions in the sense that were all attended by the same oncologist (Dr.
this is not a randomized study. Bevacizumab has not Gironés). Possible confounding factors for treatment
been specifically studied in older patients. As few (physician bias) have been prevented. The number
[39]
[37]
elderly patients were treated with bevacizumab we are of cases was relatively high. To date, most studies of
unable to draw conclusions. Probably the two patients elderly lung cancer patients have been from subgroup
suitable for first line bevacizumab were carefully analysis of phase III studies or were specific studies for
selected. At present we are exploring bevacizumab in elderly patients with fewer patients. Studies with high
elderly patients selected using geriatric assessment numbers of patients were retrospective. [6,38]
(ClinicalTrials.gov identifier: NCT01980472). For
chemotherapy combinations (vinorelbine, gemcitabine, In conclusion, patients do benefit from aggressive
paclitaxel, pemetrexed, docetaxel) we did not find any chemotherapy regardless of their age. Our observational
differences in elderly patients, which leads us to draw data provide an opportunity to understand the effects of
the conclusion that, as in younger patients, the benefits treatment when applied in routine practice and assess
of chemotherapy have reached a plateau. [6,38] whether outcomes are comparable to those obtained in
clinical trials. Approximately 45% of the elderly patients
Our results indicate that chemotherapy treatment is with advanced NSCLC seen at our routine clinical
strongly associated with greater survival. Furthermore, practice received active treatment with chemotherapy,
the magnitude of this benefit is comparable with that and this prolonged survival in a similar way to in their
seen in clinical trials, or even more so. The closeness younger counterparts. The most significant advances
of these estimates suggests that with adequate in median overall survival have been in cases of
adjustments for patients’ characteristics, observational lung cancer unrelated to smoking (EGFR-mutations).
studies can provide very useful information on the Unfortunately, smoking remains the main cause of
Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ September 30, 2016 385