Elderly patients with advanced NSCLC benefited from chemotherapy

Patients with advanced non–small cell lung cancer aged older than 65 years do not usually receive chemotherapy, but results of a study showed a clear survival advantage for such patients when they undergo chemotherapy.

Researchers reviewed data on 21,285 patients collected in the SEER database. The cohort included patients diagnosed with stage IV NSCLC or stage III disease with pleural effusion from 1997 to 2002. The results were published in the Journal of Clinical Oncology.

Researchers estimated the effect of any chemotherapy and first-line treatment with a platinum doublet vs. single-agent therapy on the probability of 1-year survival and survival duration. Survival was calculated from the diagnosis date for any chemotherapy or first treatment date for comparisons across treatment regimens to date of death or censoring.

Researchers determined that 25.8% of the cohort had received first-line chemotherapy and 30.1% received any chemotherapy. Nearly 40% of patients (37.1%) underwent second-line chemotherapy, and those who received platinum-doublet first-line regimens were more likely to receive second-line therapy.

There was a clear OS benefit for patients assigned chemotherapy (7.1 vs. 2.5 months). After controlling for disease and patient characteristics, researchers found that patients who underwent chemotherapy saw their risk for death decrease by more than half (HR=0.558; 95%CI, 0.547-0.569).

Adjusted 1-year survival was 11.6% without chemotherapy (95% CI, 11.1%-12%) and 27% with chemotherapy (95% CI, 26.4%-27.6%). For patients who received chemotherapy, median survival was 7.7 months for platinum doublets vs. 5.3 months for single-agent therapy.

Davidoff and colleagues found that survival outcomes were superior for those treated with platinum-doublet chemotherapy (HR=0.734; 95%CI, 0.705-0.765). The adjusted 1-year survival probabilities were 30.1% for platinum doublets (95% CI, 28.9%-31.4%) compared with 19.4% for patients receiving single-agent therapy (95% CI, 18.3%-20.4%).

Patients who were married, non-white and with stage IIIb disease had improved survival, whereas increased comorbidity and male sex were associated with an increased mortality risk. Researchers said demographics, underlying health status and tumor characteristics dictated whether patients received chemotherapy. Age was a particularly important factor — patients aged 80 years and older were less likely to be treated than patients in the youngest age group.

Additionally, patients with one or two or more poor performance status proxy indicators were less likely to be treated than patients with no indicators. Blacks and patients enrolled in Medicaid or Medicare savings programs were also less likely to be treated.

Davidoff AJ. J Clin Oncol. 2010;28:2191-2197.