Old Age Doesn't Compromise Upper-GI Cancer Survival

Abstract

Elderly patients have survival outcomes similar to those of younger participants in clinical trials of treatments for metastatic esophageal and gastric cancers, but their higher rates of severe adverse events suggest a need for more tolerable regimens for older patients, according to a retrospective analysis. Aminah Jatoi, MD, and her colleagues pooled data from eight consecutive North Central Cancer Treatment Group (NCCTG) trials that enrolled patients with similar distributions of demographic and disease characteristics from 1987 through 2006. The population of 367 patients comprised 154 who were aged 65 years or older and 213 who were younger. All received palliative chemotherapy for incurable metastatic gastric or esophageal adenocarcinoma. Dr. Jatoi reported that older patients had worse overall well-being (performance scores) than younger patients. Yet the elders’ median overall and progression-free survival durations were similar: 6.0 vs. 6.7 months of overall survival, respectively (P = .45) and 3.3 months of progression-free survival in both groups (P = .46). Also, the average time on first-line chemotherapy was 3 months for both age groups. Older patients experienced significantly higher incidence of grade 3/4 hematologic and nonhematologic adverse events, however. These included leukopenia (28% vs. 18%; P = .02); stomatitis (6% vs. 1%; P = .01); fatigue (15% vs. 5%; P = .0006); and vomiting (7% vs. 2%; P = .03). Overall rates of grade 4 adverse events were substantially higher in older patients compared with their younger counterparts (40% vs. 28%; P = .02), regardless of whether older patients were defined as being 65 years of age and older or 70 years of age and older. “It was important to do this study because there is a rising incidence in esophageal adenocarcinoma in the general population. But this is particularly true in older patients,” Dr. Jatoi, professor of medicine at the Mayo Clinic, Rochester, Minn., reported. Many studies of various tumor types have looked back and shown that elderly patients had survival similar to that of younger patients but a greater degree of toxicity, she added. “The question is, Is this true for metastatic esophageal and gastric cancers?” said Dr. Jatoi. “Age alone should not preclude trial entry as older patients in this study manifested comparable survival,” she concluded, with the caveat that these findings should be interpreted with caution because this patient population may consist of a culled group of healthier older patients. “This is one of many analyses of clinical trials that show the older population, in general, does as well as the younger,” said Malcolm J. Moore, MD, of the Ontario Cancer Institute and the University of Toronto. “It does not mean that every elderly patient should get aggressive chemotherapy; it just means that we can use parameters, such as performance status and comorbidities, to select the appropriate patients, and, if we do this, those elderly patients will receive the same degree of benefit as do younger ones.”