Systemic therapy for elderly patients with non–small cell lung cancer: Where do we stand in 2019?

Aggarwal, Charu; Langer, Corey J.

doi:10.1002/cncr.32625

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…While there was no OS decrement associated with ICIs in trial-ineligible populations, there are consequences to its use. Use of ICIs for patients with poor PS is associated with lower hospice enrollment, more inpatient deaths, and more treatment during the last month of life . It is critical to ensure that vulnerable, trial-ineligible patients are not exposed to non–evidence-based therapies that could cause harm and contradict patient goals …”

Section: Discussionmentioning

confidence: 99%

Uptake and Survival Outcomes Following Immune Checkpoint Inhibitor Therapy Among Trial-Ineligible Patients With Advanced Solid Cancers

et al. 2021

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Immune checkpoint inhibitors (ICIs) are part of standard of care for patients with many advanced solid tumors. Patients with poor performance status or organ dysfunction are traditionally ineligible to partake in pivotal randomized clinical trials of ICIs.OBJECTIVE To assess ICI use and survival outcomes among patients with advanced cancers who are traditionally trial ineligible based on poor performance status or organ dysfunction. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted in 280 predominantly community oncology practices in the US and included 34 131 patients (9318 [27.3%] trial ineligible) who initiated first-line systemic therapy from January 2014 through December 2019 for newly diagnosed metastatic or recurrent nontargetable non-small cell lung, urothelial cell, renal cell, or hepatocellular carcinoma. Data analysis was performed from December 1, 2019, to June 1, 2021.EXPOSURES Trial ineligibility (Eastern Cooperative Oncology Group performance status Ն2 or the presence of kidney or liver dysfunction); first-line systemic therapy. MAIN OUTCOMES AND MEASURESThe association between trial ineligibility and ICI monotherapy uptake was assessed using inverse probability-weighted (IPW) logistic regressions. The comparative survival outcomes following ICI and non-ICI therapy among trial-ineligible patients were assessed using treatment IPW survival analyses. Because we observed nonproportional hazards, we reported 12-month and 36-month restricted mean survival times (RMSTs) and time-varying hazard ratios (HRs) of less than 6 months and 6 months or greater. RESULTS Among the overall cohort (n = 34 131), the median (IQR) age was 70 (62-77) years; 23 586 (69%) were White individuals, and 14 478 (42%) were women. Over the study period, the proportion of patients receiving ICI monotherapy increased from 0% to 30.2% among trial-ineligible patients and 0.1% to 19.4% among trial-eligible patients. Trial ineligibility was associated with increased ICI monotherapy use (IPW-adjusted odds ratio compared with non-ICI therapy, 1.8; 95% CI, 1.7-1.9). Among trial-ineligible patients, there were no overall survival differences between ICI monotherapy, ICI combination therapy, and non-ICI therapy at 12 months (RMST, 7.8 vs 7.7 vs 8.1 months) or 36 months (RMST, 15.0 vs 13.9 vs 14.4 months). Compared with non-ICI therapy, ICI monotherapy showed evidence of early harm (IPW-adjusted HR within 6 months, 1.2; 95% CI, 1.1-1.2) but late benefit (adjusted HR among patients who survived 6 months, 0.8; 95% CI, 0.7-0.8). CONCLUSIONS AND RELEVANCEIn this cohort study, compared with trial-eligible patients, trial-ineligible patients with advanced cancers preferentially received first-line ICI therapy. A survival difference was not detected between ICI and non-ICI therapies among trial-ineligible patients. Positive results for ICI in phase 3 trials may not translate to this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Uptake and Survival Outcomes Following Immune Checkpoint Inhibitor Therapy Among Trial-Ineligible Patients With Advanced Solid Cancers

et al. 2021

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“…It is effective in suppressing the proliferation of cancer cells, eliminating residual cancer cells within the body, and ultimately prolonging the survival of patients. However, elderly patients may experience challenges related to drug absorption, distribution, metabolism, and clearance due to age-related reductions in body function, increased prevalence of underlying diseases, reduced organ reserve capacity, and alterations in physiological functions [4,5]. Furthermore, tiredness, nausea, and anxiety are more prevalent in older cancer patients, and, when combined with other symptoms and comorbidities, they lower the QOL that these patients feel [6].…”

Section: Introductionmentioning

confidence: 99%

The association between physical activity levels and quality of life in elderly lung cancer patients undergoing chemotherapy: a cross-sectional study

Hou,

Lian,

Liu

et al. 2024

Preprint

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Objective This study aimed to investigate the association between physical activity(PA) levels and quality of life(QOL) in elderly lung cancer patients undergoing chemotherapy. Methods 208 elderly lung cancer patients undergoing chemotherapy were recruited by convenient sampling at two tertiary A hospitals in Guangxi from October 2023 to March 2024. The Evaluation of PA Levels by the International Physical Activity Questionnaire Short Form (IPAQ-SF) was conducted and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was utilized to measure the QOL. Multiple linear regression was used to identify factors correlated with QOL. Results Out of 208 elderly patients with lung cancer who were undergoing chemotherapy, 119 (57.20%) had low-level PA, 79 (38.00%) had moderate-level PA, and 10 (4.80%) had high-level PA. The mean score of FACT-L was 95.41 ± 15.01, and FACT-L was correlated with age, residency, education level, and per capita monthly household income (p < 0.05). Moderate to high PA levels explained 19.4% of the variation in QOL among elderly patients undergoing chemotherapy for lung cancer. Conclusion Elderly lung cancer patients undergoing chemotherapy exhibited lower levels of PA. The increase in PA levels was associated with better QOL. Treatment options for elderly lung cancer patients undergoing chemotherapy may involve PA plans to boost their QOL. It's vital to evaluate the patient's physical condition and functional level when creating these plans to ensure safety and effectiveness, thereby increasing patient engagement and maximizing enhancements in their QOL.

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“…This might be explained for at least two reasons listed as follows: 1. the survival rates differ significantly within the same stage subgroup [ 7 – 9 ]; 2. Other potential prognostic factors were omitted, such as grade, the number of metastatic lymph nodes [ 10 – 12 ], age [ 13 , 14 ], etc. While several clinical models have been developed to improve risk stratification and survival prediction in NSCLC [ 15 – 17 ], few exist for the analysis of optimal postoperative treatment regimens (without adjuvant therapy [AT], adjuvant chemotherapy [ACT], adjuvant chemoradiotherapy [ACRT]) in elderly patients with LSCC.…”

Section: Introductionmentioning

confidence: 99%

Online decision tools for personalized survival prediction and treatment optimization in elderly patients with lung squamous cell carcinoma: a retrospective cohort study

Shao,

Luo,

et al. 2023

BMC Cancer

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Background Despite major advances in cancer therapeutics, the therapeutic options of Lung Squamous Cell Carcinoma (LSCC)-specific remain limited. Furthermore, the current staging system is imperfect for defining a prognosis and guiding treatment due to its simplicity and heterogeneity. We sought to develop prognostic decision tools for individualized survival prediction and treatment optimization in elderly patients with LSCC. Methods Clinical data of 4564 patients (stageIB-IIIB) diagnosed from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for prognostic nomograms development. The proposed models were externally validated using a separate group consisting of 1299 patients (stage IB-IIIB) diagnosed from 2012–2015 in China. The prognostic performance was measured using the concordance index (C-index), calibration curves, the average time-dependent area under the receiver operator characteristic curves (AUC), and decision curve analysis. Results Eleven candidate prognostic variables were identified by the univariable and multivariable Cox regression analysis. The calibration curves showed satisfactory agreement between the actual and nomogram-estimated Lung Cancer-Specific Survival (LCSS) rates. By calculating the c-indices and average AUC, our nomograms presented a higher prognostic accuracy than the current staging system. Clinical usefulness was revealed by the decision curve analysis. User-friendly online decision tools integrating proposed nomograms were created to estimate survival for patients with different treatment regimens. Conclusions The decision tools for individualized survival prediction and treatment optimization might facilitate clinicians with decision-making, medical teaching, and experimental design. Online tools are expected to be integrated into clinical practice by using the freely available website (https://loyal-brand-611803.framer.app/).

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Systemic therapy for elderly patients with non–small cell lung cancer: Where do we stand in 2019?

Cited by 5 publications

References 22 publications

Uptake and Survival Outcomes Following Immune Checkpoint Inhibitor Therapy Among Trial-Ineligible Patients With Advanced Solid Cancers

Uptake and Survival Outcomes Following Immune Checkpoint Inhibitor Therapy Among Trial-Ineligible Patients With Advanced Solid Cancers

The association between physical activity levels and quality of life in elderly lung cancer patients undergoing chemotherapy: a cross-sectional study

Online decision tools for personalized survival prediction and treatment optimization in elderly patients with lung squamous cell carcinoma: a retrospective cohort study

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