Treatment strategies for locally advanced non-small cell lung cancer in elderly patients: Translating scientific evidence into clinical practice

Bonanno, Laura; Attili, Ilaria; Pavan, Alberto; Sepulcri, Matteo; Pasello, Giulia; Rea, Federico; Guarneri, Valentina; Conté, Pierfranco

doi:10.1016/j.critrevonc.2021.103378

Cited by 14 publications

(16 citation statements)

References 80 publications

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“…The incidence of LUAD has substantially decreased, partly due to reductions in smoking rates in developed countries ( 5 ). Treatment of NSCLC is focused on surgery, chemotherapy, and radiotherapy ( 6 ). In the past decades, identification of targetable alteration in patients with NSCLC has improved its treatment ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

KRT8 Serves as a Novel Biomarker for LUAD and Promotes Metastasis and EMT via NF-κB Signaling

Chen

Pan

et al. 2022

Front. Oncol.

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Keratin 8 (KRT8) is the major component of the intermediate filament cytoskeleton and aberrant expression in multiple tumors. However, the role of KRT8 in lung adenocarcinoma (LUAD) remains unclear. In the present study, KRT8 expression was found to be upregulated along with prognosis and metastasis in LUAD. Kaplan–Meier analysis presented that the 5-year OS and DSS rates were significantly better among patients with low KRT8 expression compared to those with high expression. Correlation analysis showed that KRT8 expression was significantly associated with gender (P = 0.027), advanced T stage (P = 0.001), advanced N stage (P = 0.048), and advanced pathologic stage (P = 0.025). Univariate Cox analysis demonstrated that KRT8 was a predictor of OS [hazard ratio (HR) = 1.526; 95% confidence interval (CI) 1.141–2.040; P = 0.004] and DSS (HR = 1.625; 95% CI 1.123–2.353; P = 0.010) in the TCGA database. Importantly, downregulation of KRT8 obviously suppressed cell proliferation, cell migration, invasion, and EMT as well as induced cell apoptosis. KRT8 knockdown significantly inhibited NF-κB signaling, suggesting a potential mechanism. Overall, our results indicated that KRT8 could regulate lung carcinogenesis and may serve as a potential target for antineoplastic therapies.

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Section: Introductionmentioning

confidence: 99%

KRT8 Serves as a Novel Biomarker for LUAD and Promotes Metastasis and EMT via NF-κB Signaling

Chen

Pan

et al. 2022

Front. Oncol.

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“…In the management of elderly patients (≥65 years old) with NSCLC, surgery is still the main choice for elderly patients ( 5 ). In general, treatment-related toxicity increases according with age ( 10 ). Patients over 70 years old have similar survival rates compared with patients between 55 and 69 years old with locally advanced NSCLC ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…Patients over 70 years old have similar survival rates compared with patients between 55 and 69 years old with locally advanced NSCLC ( 31 ). Therefore, treatment of elderly advanced NSCLC patients should include chemotherapy, radiotherapy, and surgery in select cases ( 10 ). In recent studies, stereotactic ablative radiotherapy has emerged as a treatment alternative instead of surgery for early stage NSCLC ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…Ganti et al demonstrated in a cohort of 1,338 elderly NSCLC patients that surgery is an independent factor in stage I and stage II NSCLC octogenarians ( 9 ). Surgical resection is also the primary treatment choice for a subset of elderly patients with advanced NSCLC ( 10 ). Since patients greater than 80 years old are seldom included in randomized clinical trials, prospective studies that are relevant to elderly NSCLC patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Identifying octogenarians with non-small cell lung cancer who could benefit from surgery: A population-based predictive model

Chao

Wang

et al. 2022

Front. Surg.

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BackgroundAs the population ages, there will be an increasing number of octogenarian patients with non-small cell lung cancer (NSCLC). In carefully selected elderly patients, surgery can improve long-term survival. To identify candidates who would benefit from surgery, we performed this study and built a predictive model.Materials and methodsData from NSCLC patients over 80 years old were obtained from the Surveillance, Epidemiology and End Results database. A 1:1 propensity score matching was performed to balance the clinicopathological features between the surgery and non-surgery groups. Kaplan-Meier analyses and log-rank tests were used to assess the significance of surgery to outcome, and Cox proportional-hazards regression and competing risk model were conducted to determine the independent prognostic factors for these patients. A nomogram was built using multivariable logistic analyses to predict candidates for surgery based on preoperative factors.ResultsThe final study population of 31,462 patients were divided into surgery and non-surgery groups. The median cancer-specific survival time respectively was 53 vs. 13 months. The patients’ age, sex, race, Tumor, Node, Metastasis score, stage, chemotherapy use, tumor histology and nuclear grade were independent prognostic factors. Apart from race and chemotherapy, other variates were included in the predictive model to distinguish the optimal surgical octogenarian candidates with NSCLC. Internal and external validation confirmed the efficacy of this model.ConclusionSurgery improved the survival time of octogenarian NSCLC patients. A novel nomogram was built to help clinicians make the decision to perform surgery on elderly patients with NSCLC.

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“…Elderly patients represent a high proportion of the NSCLC population ( 9 ). Because these patients are more frequently frail and have more comorbidities, the risks associated with full dose of chemotherapy are higher, thus limiting the treatment options available ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

et al. 2022

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The combination of immunotherapy and chemotherapy has a synergic effect in non-small cell lung cancer (NSCLC). However, the elderly are often excluded from clinical trails due to their poor health status and more comorbidities. We sought to assess the efficacy and safety of low-dose nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus tislelizumab (an anti-PD-1 antibody) in elderly patients with advanced NSCLC. In this phase 2 clinical trail, eligible patients were those aged ≥65 years with metastatic NSCLC who had disease progression after treatment with ≥1 line of chemotherapy or targeted therapy. Patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) variations were eligible if they demonstrated disease progression after treatment with ≥1 corresponding inhibitor. Primary endpoints were progression-free survival and safety/tolerability. Secondary endpoints included objective response rate and overall survival. Among 29 patients enrolled from May 2019 through August 2020, 21 (72.4%) had adenocarcinoma, 17 (58.6%) had a performance status of 2, 8 (27.6%) had asymptomatic brain metastases, and 13 (44.8%) had EGFR/ALK variations. As of the data cutoff point on April 1, 2021, median progression-free survival and overall survival were 9.5 months and 16.5 months, respectively. Ten patients achieved a partial response (objective response rate of 34.5%). Seventeen (58.6%) patients had ≥1 treatment-related adverse event, with grade 3 events seen in 3 patients (10.3%). The most common adverse events were fatigue (20.7%), fever (17.2%), abnormal liver function (17.2%), and rash (17.2%). These results suggest that low-dose nab-paclitaxel plus tislelizumab is well tolerated and effective in elderly patients with advanced NSCLC, including those with EGFR/ALK variations.

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Treatment strategies for locally advanced non-small cell lung cancer in elderly patients: Translating scientific evidence into clinical practice

Cited by 14 publications

References 80 publications

KRT8 Serves as a Novel Biomarker for LUAD and Promotes Metastasis and EMT via NF-κB Signaling

KRT8 Serves as a Novel Biomarker for LUAD and Promotes Metastasis and EMT via NF-κB Signaling

Identifying octogenarians with non-small cell lung cancer who could benefit from surgery: A population-based predictive model

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

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