Significance of pretreatment comorbidities in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy or epidermal growth factor receptor-tyrosine kinase inhibitor

Irisa, Kaoru; Masago, Katsuhiro; Togashi, Yosuke; Fujita, Shiro; Hatachi, Yukimasa; Fukuhara, Akiko; Sakamori, Yuichi; Kim, Yung Hak; Mio, Tadashi; Mishima, Michiaki

doi:10.1007/s12032-010-9764-0

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Most observational studies have found that cancer patients with comorbidities have poorer survival than patients without comorbidities 4–11,24,28–30. Cohort studies with 5–7 years of follow-up have reported 1.1- to 5.8-fold higher mortality for breast cancer patients with any comorbidity compared to patients with no comorbidity 4,20,26,31,32.…”

Section: Resultsmentioning

confidence: 99%

The impact of comorbidity on cancer survival: a review

Søgaard¹,

Thomsen²,

Bossen³

et al. 2013

CLEP

470

403

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BackgroundA number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence.MethodsAll English-language articles published during 2002–2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted.ResultsOur search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity.ConclusionDespite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.

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Section: Resultsmentioning

confidence: 99%

The impact of comorbidity on cancer survival: a review

Søgaard¹,

Thomsen²,

Bossen³

et al. 2013

CLEP

470

403

View full text Add to dashboard Cite

show abstract

“…The study by Chen et al [ 24 ] (survival predictor—use of TKI) were similar to our study but may not be directly comparable as patients aged 70–79 years were excluded. On the contrary, the studies by Irisa et al [ 25 ] (survival predictor—histology subgroup, number of comorbidities, and CCI score) and Girones et al [ 26 ] (survival predictor—TMN staging) shared the same age cutoff of 70 years and overall study design. We have considered all the variables mentioned in these studies, but none was found to be a significant survival predictor; one possible explanation of this might be a sample bias as those with multiple comorbidities might not have been referred for treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Chen et al [ 24 ] found that in Chinese patients with advanced NSCLC aged 80 years or older, patients who received EGFR– TKI therapy had a significantly better prognosis (hazard ratio: 0.56), a benefit not found in chemotherapy or radiotherapy group. Irisa et al [ 25 ] found that NSCLC histology (HR 1.631), three or more comorbidities (HR 1.317), and a CCI of more than three (HR 1.321) were independent negative prognostic factors. Girones et al [ 26 ], however, found that TMN clinical staging (log-rank: p < 0.001), not CCI, was related to survival.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes in Elderly with Advanced-Stage Non-small Cell Lung Cancer

Tam

Wong

et al. 2013

Lung

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PurposeLung cancer remains the top cause of cancer morbidity and mortality in the world. Although the identification of epidermal growth factor receptor (EGFR) gene mutations could predict efficacy of tyrosine kinase inhibitor (TKI), testing for predictive biomarkers are not always possible due to tissue availability. The overall therapeutic decision remains a clinical one for a significant proportion of elderly patients with advanced stage lung cancer but no known EGFR mutation status. The purpose of this study was to compare the outcome of drug treatment modalities in progression-free survival (PFS) and overall survival (OS) for elderly with advanced-stage non-small cell lung cancer (NSCLC) and to identify clinical parameters that could predict treatment outcome. MethodsClinical records of patients aged 70 years or older with advanced-stage NSCLC who have received treatment were reviewed. A group of gender- and histology-matched subjects younger than age 70 years were identified as controls. ResultsFifty-six elderly patients were included. The median age at diagnosis was 73 years; 60.7 % received only one line of treatment. Baseline performance status (PS) was the only predictor of improved PFS (p = 0.042) and OS (p = 0.002). There was no difference in survival between the upfront chemotherapy and the TKI groupsConclusionsIn elderly with advanced-stage NSCLC without known EGFR mutation status, use of EGFR–TKI and chemotherapy resulted in comparable survival benefits. Age was not predictive of worse treatment outcome. The baseline PS should be taken into consideration in the therapeutic decision in elderly with NSCLC where the EGFR mutation status is not known.

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“…Moreover, the usefulness of abbreviated instruments [32,37], such as the Cancer Aging Research Group and the Chemotherapy Risk Assessment Scale for High-age patients tools, is not definitively assessed. Despite this, the European Organization for Research and Treatment of Cancer Elderly Task Force and the International Society for Geriatric Oncology strongly recommend the application of CGA-based approaches in clinical practice [38].…”

Section: Clinical Evaluation Of Elderly Patients With Cancermentioning

confidence: 99%

Current and Emerging Options in the Management of EGFR Mutation-Positive Non-Small-Cell Lung Cancer: Considerations in the Elderly

2015

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The elderly population with cancer is increasing worldwide. Currently, the median age at lung cancer diagnosis is approximately 70 years. Clinicians are increasingly dealing with a population of elderly non-small-cell lung cancer patients characterised by relevant co-morbidities and ageing-related characteristics, making treatment choice more challenging. Robust evidence demonstrated that activating mutations in the epidermal growth factor receptor (EGFR) gene are the best predictor for sensitivity to EGFR tyrosine kinase inhibitors. Nine large phase III trials conducted in both the Asian and Caucasian populations demonstrated that gefitinib, erlotinib and afatinib are superior to standard platinum-based chemotherapy as front-line treatment and subgroup analyses confirmed the superiority of erlotinib or gefitinib over chemotherapy in the second-line setting. Although no large phase III trials have been specifically conducted in EGFR mutation-positive (EGFR (mut+)) elderly non-small-cell lung cancer patients, available data, coming from subgroup analysis, retrospective series or small prospective phase II trials, replicated in the elderly the results observed in the general population, thus suggesting that age per se does not represent a criterion for treatment selection. In addition, the favourable toxicity profile of EGFR-tyrosine kinase inhibitors makes these agents the preferred option in such a group of patients, for which concomitant medications are often required.

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Significance of pretreatment comorbidities in elderly patients with advanced non-small-cell lung cancer treated with chemotherapy or epidermal growth factor receptor-tyrosine kinase inhibitor

Cited by 6 publications

References 28 publications

The impact of comorbidity on cancer survival: a review

The impact of comorbidity on cancer survival: a review

Treatment Outcomes in Elderly with Advanced-Stage Non-small Cell Lung Cancer

Current and Emerging Options in the Management of EGFR Mutation-Positive Non-Small-Cell Lung Cancer: Considerations in the Elderly

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