Time and chemotherapy treatment trends in the treatment of elderly patients (age ⩾70 years) with small cell lung cancer

Abstract

Platinum-based treatment for small cell lung cancer (SCLC) has been established since 1995. This study investigates treatment outcome of elderly patients (age X70 years) with SCLC over the past 20 years in a large UK cancer centre. Comparison of all-cause survival was assessed in patients presenting between two predefined time periods : 1982 -1994 and 1995 -2003. All the survival analysis were adjusted for stage and performance status and age if appropriate. Survival between different chemotherapy treatment regimens was compared. A total of 322 elderly patients (31% of all) registered between 1982 -2003 received chemotherapy for SCLC. Patients presenting in 1995 -2003 had an overall better median survival (43 vs 25 weeks) and a 1-year survival (37 vs 14%) than patients presenting in 1982 -1994. This applied to patients with both limited and extensive stage disease and all age groups. There was a trend towards the use of more platinum-based treatments in the later cohort but the use of radiotherapy remained constant. Patients who received platinum combinations (Carboplatin or Cisplatin) had significantly improved survival over those who received single agents or other combinations (Po0.001) and there was no significant difference between carboplatin and cisplatin (P ¼ 0.7). The analysis demonstrates that there has been a significant improvement in survival for elderly patients with lung cancer treated by chemotherapy in the past 20 years despite more very elderly patients being treated with a poorer performance status. This change is probably multifactorial and may be due to the increased use of platinum-based treatment and improved supportive care.

Compliance and Outcome of Elderly Patients Treated in the Concurrent Once-Daily Versus Twice-Daily Radiotherapy (CONVERT) Trial

“…There are very little data to guide the management of octogenarians with LS-SCLC. Most of the evidence comes from small retrospective series evaluating outcomes in patients with both limited- and extensive-stage disease, often treated with chemotherapy alone and with limited toxicity outcomes 33, 34, 35. Because of the small number of octogenarians in the CONVERT trial, we cannot draw any firm conclusions on the appropriate management of these patients; however, given the high rates of observed toxicity in this analysis, this should be further investigated in larger studies.…”

How do patient and hospital features influence outcomes in small-cell lung cancer in England?

“…This supports our evidence that it is not the associated comorbidity rise with age that is wholly responsible for the observed decline in chemotherapy use as patients get older. The apparent reluctance to provide chemotherapy in elderly patients with small-cell lung cancer is not supported by evidence of a poor safety record (Smit et al , 1989; Ludbrook et al , 2003; Yau et al , 2006). …”

Lung cancer in patients aged 80 years and over

“…There was no improvement in survival in their NSCLC patients. On the other hand, there was a significant improvement in survival for elderly SCLC patients treated by chemotherapy in the past 20 years [14,15]. Their study included only 26 (8.0%) of 322 patients aged 80 years and over and the MST in the former study period was too short to compare.…”

“…Our results in both genders were consistent with this large scale study. O'Brien et al recently reported the trends in the chemotherapeutic outcome in patients age ≥70 years with SCLC and NSCLC [14,15]. There was no improvement in survival in their NSCLC patients.…”

“…There has been an increasing interest in the treatment of elderly patients with lung cancer [5,6,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. However, clinical information regarding lung cancer patients aged 80 years and over has not been fully available since such patients are not usually included in clinical trials and retrospective care analysis.…”