A pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited‐stage small cell lung cancer in elderly patients versus younger patients

Abstract

Background Platinum and etoposide with thoracic radiation followed by prophylactic cranial irradiation constitute the standard treatment for limited‐stage small cell lung cancer (LS‐SCLC). Many patients with LS‐SCLC are elderly with comorbidities. Methods Individual patient data were collected from 11 phase 2 or 3 trials for LS‐SCLC conducted by the National Clinical Trials Network and activated from 1990 to 2010. The primary endpoint was overall survival (OS); the secondary endpoints were progression‐free survival (PFS), the rate of severe adverse events, and off‐treatment reasons. The outcomes were compared for patients 70 years old or older (elderly patients) and patients younger than 70 years (younger patients). Results Individual patient data from 1049 younger patients (81%) and 254 elderly patients (19%) were analyzed. In the multivariate model, elderly patients, in comparison with younger patients, had worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.18‐1.63; median OS for elderly patients, 17.8 months; OS for younger patients, 23.5 months) and worse PFS (HR, 1.19; 95% CI, 1.03‐1.39; median PFS for elderly patients, 10.6 months; median PFS for younger patients, 12.3 months). Elderly patients, in comparison with younger patients, experienced more grade 5 adverse events (8% vs 3%; P < .01) and more grade 3 or higher dyspnea (11% vs 7%; P = .03) but less grade 3 or higher esophagitis/dysphagia (14% vs 19%; P = .04) and less grade 3 or higher vomiting (11% vs 17%; P = .01). Elderly patients completed treatment less often, discontinued treatment because of adverse events and patient refusal more frequently, and died during treatment more frequently. Conclusions Elderly patients with LS‐SCLC have worse PFS and OS and more difficulty in tolerating therapy. Future trials should incorporate assessments of elderly patients, novel monitoring of adverse events, and more tolerable radiation and systemic therapies.

Characteristics and Clinical Outcomes of Patients With Nonsmoking Small Cell Lung Cancer in Korea

“…Our ndings are in line with those of a previous study where patients aged 70 years or younger were treated with best supportive care in only 17-23% of cases, but the percentage increased with higher age up to 75% of those aged 85 years or older [21]. Elderly SCLC patients experienced more severe adverse events, completed treatment less often, and died during treatment more frequently than younger patients [22]. However, active treatment, including chemotherapy and/or radiotherapy, has improved the survival of SCLC patients younger than 80 years of age [21].…”

Role of surgery in a case-control study of patients with clinical stage IIIA small cell lung cancer

“…Rea et al evaluated 53 patients with clinical stage III SCLC underwent surgery with perioperative neoadjuvant (19). In our study, OS in the CRT group was 20 months, which is consistent with the literature (19,23). The 30 years when chemotherapy was the first-line therapy for SCLC (24), as well as the EP (cisplatin + etoposide) and EC (carboplatin + etoposide) schemes, laid the foundation for chemotherapy for SCLC (25)(26)(27).…”

WITHDRAWN: Development and Validation of Nomograms for Predicting Survival of Elderly Patients With Stage I&nbsp;Small-cell Lung Cancer

“…All these factors probably contribute to lower survival. [28] Older age is directly linked with an unfavorable prognosis, and this variable is recommended to be considered in selecting treatment strategies. [29] The different histological types of SCLC are signi cantly associated with biological characteristics and prognosis.…”