Advanced Age Usually Not a Factor in Platinum-Based Therapy for NSCLC

PHILADELPHIA—Fit, elderly patients with non–small-cell lung cancer (NSCLC) can handle platinum-based therapy as well as younger patients, according to a secondary analysis of data from Eastern Cooperative Oncology Group (ECOG) study 5592. Corey Langer, MD, of Fox Chase Cancer Center, presented the analysis at the ASCO annual meeting.

There is a bias against treating older people as vigorously with chemotherapy as younger patients are treated, Dr. Langer observed. Advanced age alone, however, does not equate with poor performance status (PS), he said, and should not preclude patients from receiving appropriate therapy for their disease.

To settle the issue, Dr. Langer spearheaded an analysis of outcomes in ECOG 5592 using age 70 as the cutpoint. ECOG 5592 was a phase III study in which patients with stage III-IV NSCLC received a fixed dose of platinum (75 mg/m²) combined with either etoposide 100 mg/m² IV on days 1 to 3, paclitaxel (Taxol) 135 mg/m² over 24 hours, or paclitaxel 250 mg/m² over 24 hours plus G-CSF (Neupogen).

Equivalent Outcomes

The study population involved 488 patients younger than age 70 and 86 patients aged 70 and above. The secondary analysis found response rate, time to progression, and median survival to be essentially equivalent between the age groups. One-year survival was numerically higher for younger patients (38% vs 28%), as was 2-year survival (13.5% vs 11.6%), but these differences were not statistically significant, he reported.

Pretreatment Characteristics

The equivalency in outcomes was interesting in light of the fact that older patients had worse pretreatment characteristics. They generally had more cardiovascular and respiratory comorbidities and were taking more medications. This led to more treatment-related toxicity in the older group, including more severe leukopenia, more deaths from febrile neutropenia, and more “neuropsychiatric toxicity.”

Older patients, however, rated their quality of life similarly to younger patients, Dr. Langer reported.

PS Status Matters

David Gandara, MD, of the University of California, Davis, serving as discussant at the session, commented: “The question of whether the elderly represents a poor-risk group is a critical one.”

Although relatively few elderly are entered into clinical trials, he said, the US Cooperative Group database on NSCLC suggests that the “fit” elderly fare well with standard treatment approaches, as Dr. Langer’s analysis showed.

“Poor risk can then be defined as PS 2, with or without low albumin or weight loss or comorbid conditions. A greater proportion of the elderly do fall into this poor-risk category,” Dr. Gandara noted.

Further, he said, “PS 2 patients are the ones who do poorly with the aggressive new-agent/platinum regimens. New trials from SWOG and ECOG, will focus on assessing the tolerability and benefits in poor-risk patients independent of age.”