Patient Summary: Motexafin gadolinium (MGd) combined with prompt whole brain radiation therapy (RT) prolongs time to neurologic progression in non-small cell lung cancer (NSCLC) patients with brain metastases: Results of a phase III trial
Adjuvant chemotherapy in elderly patients: An analysis of National Cancer Institute of Canada Clinical Trials Group and Intergroup BR.10
There have been several studies showing the benefit of chemotherapy in surgically resected non small cell lung cancer (NSCLC). Unfortunately, most studies have limited numbers of elderly patients enrolled in them, so it has been difficult to apply these results to patients over 65. This Canadian group analysis is a retrospective look at previous studies conducted by their group; that is, they looked back through records to gather the data presented.
Records of patients with stage IB or II NSCLC that was completely resected by the surgical team were examined. The investigators found that patients over 65 were more likely to receive less chemotherapy than their younger counterparts. It is unclear if this is a result of intolerable side effects, physician bias or concern for safety in the elderly, or patients declining more chemotherapy. Most likely it is a combination of these factors. Of note, the rates of grade 3 or 4 (more severe) hematologic and non-hematologic toxicities were not statistically different between the elderly and young patients. Despite this, fewer elderly patients completed all chemotherapy (40% elderly vs 56% young); and more elderly patients refused treatment (40% elderly vs 23% young).
Despite receiving less chemotherapy, the elderly patients still derived significant benefit from adjuvant chemotherapy (chemo after surgery). Elderly patients who received chemotherapy had a significant improvement in overall survival (66% vs 46%, p=0.04). There was no statistically significant difference seen in overall survival when comparing elderly with younger patients. There were very small differences noted in overall survival when comparing patients aged <65, 66-70, 71-75, and >75.
This study should be followed up with a randomized trial of elderly patients, but it further makes the point that elderly patients should not be denied chemotherapy based on age alone.