Lung Cancer Patients Age Research Articles

Quality of life after treatment with immune checkpoint inhibitors for lung cancer; the impact of age

IntroductionImmune checkpoint inhibitors (ICIs) have revolutionized lung cancer treatment. However, it remains unclear as to whether changes in Health-Related Quality-of-Life (HRQoL) are associated with the age of lung cancer patients treated using ICIs. This study aimed to evaluate this possible association and to compare ICI-treated patients’ HRQoL scores with normative data of an age-matched non-cancer general population. MethodsLung cancer patients from the OncoLifeS data-biobank were included if they were treated with ICIs, irrespective of other treatments, at the University Medical Center Groningen between 2015 and 2021 and had completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTCQLQ-C30), both at the start of ICI treatment and after six months. Association of age as a continuous variable (per 10 years) and changes in HRQoL scores between baseline and 6 months was assessed using multivariable regression analyses. Clinical relevance of differences in HRQoL scores between OncoLifeS and the general population was classified into trivial, small, medium, and large, for three age groups (<60, 60–69 and ≥ 70 years). Results151 patients were included with a mean age of 65.8 years. An increase in age per 10 years was associated with a larger decrease in the summary HRQoL score(β = -3.28,CI95%-6.42;-0.14), physical(β = -4.8, CI95% −8.71;-0.88), cognitive(β = −4.51,CI95%-8.24;−0.78), role functioning(β = −5.41,CI95%-10.78;−0.05), symptom burden(β = −3.66,CI95%-6.6;-0.73), and smaller negative changes in financial difficulties(β = 6.5 95 % CI 3.16; 9.85). OncoLifeS HRQoL scores were lower than those of the general population and differences were most often classified as large and medium. ConclusionOlder lung cancer patients experience larger deteriorations in most HRQoL domains after 6 months of ICI treatment. Also, these patients showed significantly lower HRQoL scores compared to the general population.

Analysis of miR-375-3p, miR-197-3p, and miR-15a-5p Expression and Their Clinical Relevance as Biomarkers in Lung Cancer.

Background: MicroRNAs (miRNAs) play an important regulatory role and serve as biomarkers in various human cancers. However, their role in the prognosis and predicting response to therapy in Indian lung cancer patients is not fully explored. Methods: We collected surgically resected tumors and paired adjacent normal lung tissues from 29 early-stage and tissue biopsies from 103 locally advanced and metastatic lung cancer patients in this prospective study. We quantified the expression levels of miR-375-3p, miR-197-3p, and miR-15a-5p using TaqMan Advanced miRNA Assays. We correlated miRNAs expression with response to therapy and survival outcomes. Results: The median age of lung cancer patients was 60 years. We found significant overexpression of miR-375-3p and miR-197-3p in the tumors compared to paired normal lung tissues. Higher expression of miR-375-3p was observed more frequently in responders compared to nonresponders. The expression of miR-375-3p and miR-197-3p was able to differentiate patients of lung adenocarcinoma from lung squamous cell carcinoma. We did not find any correlation between miRNAs expression and survival outcomes. Conclusion: Overexpression of miR-375-3p and miR-197-3p might contribute to lung carcinogenesis. The expression of miR-375-3p may assist in predicting therapeutic response. More prospective studies are warranted to evaluate the potential of miR-375-3p as a predictive biomarker of response to therapy.

Clinicopathological Profile of Lung Cancers at an Institute from South India—A Record Based Retrospective Cohort Study

Introduction: Apart from smoking as the known risk factor for lung cancer, recent developments implicate occupational exposure to carcinogens, indoor air pollution and dietary factors as other causative agents. In our study, we have analyzed the clinical and pathological profile of lung cancer patients treated at our center over a period of 8 years. Aim: To find the demographic and clinicopathological profile of lung cancer patients admitted to the oncology unit. Methods: This retrospective record based analysis includes a cohort of 1248 patients diagnosed with lung cancer, at a tertiary cancer care center in Bangalore, South India. This study includes data of patients admitted during the period 2010 to 2018, retrieved from the Hospital’s Electronic Medical Records (EMR). Their demographic profile, clinical correlates, radiological profile and diagnostic details were studied. Benign tumours, malignant pleural disease and sarcomatoid tumors were excluded from this study. Results: Adenocarcinoma (AC) was detected among 70.4% of patients, Squamous cell carcinoma (SCC) among 15.3% and Small cell lung cancer (SCLC) among 14.3% of lung cancer admissions. Male to female ratio was 2.95:1. It was found that the median age of lung cancer patients was 61 years. >60% of lung cancer patients were from the 51 - 70 year age-group. Across the three types of cancers among the patients in Stage 3B to 4 strata, >35% received palliative chemotherapy and >20% received palliative chemotherapy + radiation. Conclusion: In our study, AC is the most common histological subtype (>70%) of lung cancer. The outcome of lung cancer patients can be considerably impacted by addressing risk factors through preventive measures implemented in the community.

Depression in lung cancer patients: A nationwide analysis.

83 Background: Depression is a major ongoing problem with cancer patients and survivors. Depression can lead to functional impairment, decreased utilization of treatment, decreased quality of life and increased suicide risk. It also leads to an extended hospital stay and increased cost of treatment. Previous studies have shown that lung cancer has a high incidence for depression. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database for the year 2016. Patients who were admitted with a principal diagnosis of Malignant Neoplasm of Bronchus and Lung (MNBL) and Major Depressive Disorder (MDD) were identified using ICD-10 codes. The prevalence of MDD and the risk factors contributing to MDD were studied. Statistical analysis was performed using STATA tool and tested with Pierson Chi-Square test. Results: A total of 79096 hospitalizations with a principal diagnosis of MNBL were identified. The prevalence of depression among lung cancer patients was found to be 12.49% (n = 9881). The mean age of lung cancer patients with depression was 62.27 ± 0.10. Females with lung cancer have more risk for MDD (15%, p &lt; 0.001). Caucasian patients with lung cancer have a higher risk of MDD (13.6%, p &lt; 0.001). It was also found that lung cancer patients who are ≤ 55 years have a higher risk of MDD (p &lt; 0.001). The average length of stay for lung cancer patients with MDD was slightly higher than lung cancer patients without MDD (6.39 days and 5.99 days respectively). The average cost of stay also had a similar pattern. Severe morbidity was seen in a greater proportion of the MDD group. Conclusions: Younger patients who are ≤ 55 years of age, Caucasians or females with lung cancer have a higher risk of MDD. Particular attention should be given to them while being in the hospital which can decrease the morbidity, and will also help to improve their quality of life.

Geospatial hot spot analysis of lung cancer patients correlated to fine particulate matter (PM2.5) and industrial wind in Eastern Thailand

Lung cancer is the most common type of cancer and is the major cause of death first among males and second among females in Thailand. Lung cancer is highly related to particulate matter (PM)—especially fine particulates with a diameter of 2.5 μm or less (PM2.5). Recent studies have indicated a strong correlation between fine particulate matter (PM2.5) and lung function diseases. Therefore, this study aims to investigate and explore the phenomenon of lung cancer and its spatial correlation to mortality and PM2.5 in Eastern Thailand from 2008 to 2012 using multidisciplinary techniques. The cancer registry was utilized as data inventory and geographical information system (GIS), Global Moran's I, Getis-Ord G statistics, Average Nearest Neighbor (ANN) tool, Inverse Distance Weighting (IDW), Local Indicators of Spatial Autocorrelation (LISA), and ordinary least square (OLS) methods to generate the PM2.5 maps to create hot spots in Eastern Thailand. The results visualize and analyze lung cancer hot spots and are adjusted for known factors such as sex and age of lung cancer patients. Choropleth maps of lung cancer incidence and mortality rates, generated for the first time, revealed that the number of male cancer patients is higher than that of females in Eastern Thailand. Global autocorrelation demonstrated considerable spatial clustering of lung cancer incidence and mortality. 91.56% of the lung cancer patients belonged to the age group of above 50 in both sexes. Significant relationships were found between the PM2.5 variable and the spatial patterns of lung cancer incidence and mortality. The Chonburi and Chanthaburi provinces were found to be the major hot spots for lung cancer incidence, which are close to industrial areas. These findings are useful in identifying the cancer registry information globally as well as locally. This study also provides a useful set of tools to identify and create hot spots in the developing countries where data and resources are major limitations.

Predictors and outcomes of venous thromboembolism in hospitalized lung cancer patients: A Nationwide Inpatient Sample database analysis.

Patients with lung cancer are at high risk of developing venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism. We sought to characterize the clinical factors associated with development of VTE and the impact of VTE on outcomes for hospitalized lung cancer patients. We analyzed data captured in the Nationwide Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). The study included all lung cancer patients hospitalized between 2006 and 2010 who had VTE captured as one of the top three discharge diagnoses. Demographics and outcomes of this population were compared to those of inpatient lung cancer patients without a VTE diagnosis. All analyses were performed using SAS version 9.3. Out of 570,304 lung cancer hospitalizations, 20,672 had a clinically relevant diagnosis of VTE, accounting for 3.6% of all events. The median age of lung cancer patients with VTE was 68 years; 48% were females, 79% were Caucasians, and 43% had metastatic disease. When compared to a lung cancer cohort without VTE (n=502,153), patients with VTE had significantly longer length of stay (LOS) (7.15 days vs. 6.05 days, OR 1.12), higher inpatient mortality (10.03% vs. 8.69%, OR 1.06), higher total hospital charges ($43,800 vs. $37,800, OR 1.07), and greater likelihood of moderate to severe disability upon discharge (55% vs. 49%, OR 1.23). VTE in hospitalized lung cancer patients is associated with longer LOS, higher inpatient mortality rates, increased cost and greater disability upon discharge compared to other inpatient lung cancer patients.

Adjuvant Chemotherapy and Targeted Therapy in Elderly Non-Small-Cell Lung Cancer Patients

Adjuvant chemotherapy and targeted therapies comprise two salient practice-changing improvements in the treatment of non-small-cell lung cancer. Despite the fact that these improvements have been largely data-driven, the following questions arise: what is the role of adjuvant chemotherapy in elderly patients with non-small-cell lung cancer? What is the role of targeted agents, such as erlotinib and bevacizumab, in older non-small-cell lung cancer patients? These questions are relevant because the current median age of lung cancer patients at diagnosis in the USA is 69 years, and the number of older patients developing this malignancy is increasing. This review provides guidance on how best to approach the use of adjuvant chemotherapy and targeted therapies in older patients with this disease.

Outcomes of combined modality treatment in elderly patients with stage III non-small cell lung cancer.

7049 Background: The use of combined modality treatment (CMT) has been demonstrated to improve survival in patients with inoperable, locally advanced NSCLC. Elderly patients have been traditionally excluded from prospective clinical trials investigating CMT and thus the optimal treatment strategy for these patients remains unclear. We retrospectively evaluated the outcomes of elderly patients who received concurrent and sequential chemoradiation. Methods: All lung cancer patients age 70 or older who received chemotherapy and radiation treatment at Mt. Sinai Medical Center for stage III NSCLC between 1997 and 2010 were analyzed from tumor registry data. Among 282 lung cancer elderly patients diagnosed with stage III disease, 64 patients (22.7 %) received CMT as part of their treatment. Patients who underwent surgery and palliative radiation were excluded. Statistical analysis was performed by log-rank, Kaplan-Meier methods, and t-test. Results: Median age at diagnosis for the CMT group was 75 years (70-87), male/female: 34/30, TNM: T4N0-1: 12, T3N1: 1, TXN2: 41, TXN3: 10. Concurrent chemoradiation was delivered in 43 cases and sequential in 21 cases. RT doses ranged from 50 to 63 Gy. The most common chemotherapy regimens used were carboplatin and taxol (44 %) and carboplatin and etoposide (15%). The most common treatment-related toxicities were esophagitis (42%), anemia (39%), and pneumonia (24%). Median survival (MST) was 19 months and 11 months in the concurrent and sequential chemoradiation groups (p=0.67). Observed two, three and five-year overall survival (OS) in the CMT group was 49.1%, 27.5%, and 12.5%, respectively. Conclusions: Although CMT is not commonly used in elderly patients with lung cancer, the treatment is feasible and beneficial for selected patients in the community setting. Interestingly, the MST of elderly patients who received CMT in this cohort was comparable to that of younger historical controls with CMT. There was also a trend for increased survival in the concurrent versus sequential chemoradiation group.

Analysis of Lung Cancer Patients Enrolled in CTEP (Cancer Therapy Evaluation Program)-Sponsored Phase I Trials

Introduction A recent review of phase I trials suggests that participation in these trials can be associated with clinical benefit and the rate of drug-related deaths is low. We conducted an analysis of the Cancer Therapy Evaluation Program (CTEP)-sponsored phase I trials to assess the outcomes of lung cancer patients enrolled in phase I trials. Materials and Methods Data from all CTEP-sponsored adult phase I trials conducted between 1997 and 2008 were analyzed. An analysis of demographics, rates of toxicities, and clinical benefit rate among patients with non–small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC), and other cancers was conducted. Results Of the 3560 patients enrolled in 136 phase I trials, 301 (8.5%) had NSCLC and 40 (1.1%) had SCLC. The median age of lung cancer patients, at 60 years, was significantly higher than patients with other cancers. The rest of the demographics were similar among the groups. The rate of Grade 3-5 toxicities was higher among NSCLC patients (54% versus 46%). The toxicity-related death rate was ≤ 1% among all groups. The clinical benefit rate and median duration in study of approximately 2 months were similar among all groups of patients. Conclusion An analysis of the CTEP-sponsored phase I trials shows that lung cancer patients enrolled in these trials have a similar incidence of toxicity-related deaths and a similar probability of clinical benefit as patients with other cancers. These data suggest that patients with progressive lung cancer following approved therapies should be considered for phase I trials.

Global Levels of Histone Modifications Predict Prognosis in Different Cancers

Cancer cells exhibit alterations in histone modification patterns at individual genes and globally at the level of single nuclei in individual cells. We demonstrated previously that lower global/cellular levels of histone H3 lysine 4 dimethylation (H3K4me2) and H3K18 acetylation (ac) predict a higher risk of prostate cancer recurrence. Here we show that the cellular levels of both H3K4me2 and H3K18ac also predict clinical outcome in both lung and kidney cancer patients, with lower levels predicting significantly poorer survival probabilities in both cancer groups. We also show that lower cellular levels of H3K9me2, a modification associated with both gene activity and repression, is also prognostic of poorer outcome for individuals with either prostate or kidney cancers. The predictive power of these histone modifications was independent of tissue-specific clinicopathological variables, the proliferation marker Ki-67, or a p53 tumor suppressor mutation. Chromatin immunoprecipitation experiments indicated that the lower cellular levels of histone modifications in more aggressive cancer cell lines correlated with lower levels of modifications at DNA repetitive elements but not with gene promoters across the genome. Our results suggest that lower global levels of histone modifications are predictive of a more aggressive cancer phenotype, revealing a surprising commonality in prognostic epigenetic patterns of adenocarcinomas of different tissue origins.

Sequential Vinorelbine and Docetaxel in Advanced Non-small Cell Lung Cancer Patients Age 70 and Older and/or with a Performance Status of 2: A Phase II Trial of the Southwest Oncology Group (S0027)

This phase II study (S0027) evaluated the efficacy and tolerability of planned sequential single-agent chemotherapy with vinorelbine followed by docetaxel in patients with advanced non-small cell lung cancer (NSCLC) age 70 and older and/or a performance status (PS) of 2. Patients with stage IIIB (pleural effusion) or stage IV NSCLC, age 70 and older with a PS of 0-1 or 2, any age, received three cycles of vinorelbine 25 mg/m days 1 and 8 every 21 days followed by three cycles of docetaxel 35 mg/m days 1, 8, and 15 every 28 days. A total of 125 patients entered the study; 117 patients were assessable for response, survival, and toxicity. Seventy-five patients were in stratum1 (age 70 and older, PS 0-1) and 42 patients in stratum 2 (PS 2, any age). Objective response was 19% (95% confidence interval [CI]: 11%-30%) and 11% (95% CI: 3%-25%) in strata 1 and 2, respectively. Median survival was 9.1 months (95% CI: 7.1-12.7) and 5.5 months (95% CI: 3.1-6.5) in strata 1 and 2, respectively. Survival at 12 months was 41% and 13% in strata 1 and 2, respectively. Grade 3/4 neutropenia was seen in 32% and 31% of patients in strata 1 and 2, respectively. Three deaths probably related to treatment were noted: one in stratum 1 and two in stratum 2. Sequential vinorelbine and docetaxel is a well-tolerated and effective regimen in comparison with reports of other treatments tested in patients with advanced NSCLC age 70 and older and/or with a PS of 2.

Sequential Vinorelbine and Docetaxel in Advanced Non-small Cell Lung Cancer Patients Age 70 and Older and/or with a Performance Status of 2: A Phase II Trial of the Southwest Oncology Group (S0027)

Sequential Vinorelbine and Docetaxel in Advanced Non-small Cell Lung Cancer Patients Age 70 and Older and/or with a Performance Status of 2: A Phase II Trial of the Southwest Oncology Group (S0027)

Results of a Phase II study of weekly docetaxel and carboplatin in Stage IIIB (with effusion) or Stage IV non-small cell lung cancer patients age ≤65 and performance status 2

This study explores if advanced NSCLC patients with ECOG PS 2 and age<or=65 years can benefit from weekly docetaxel+carboplatin, with acceptable toxicities. Fifty-nine eligible patients with Stage IIIB (effusion) or Stage IV NSCLC were registered. Patients received docetaxel 35mg/m(2) and carboplatin AUC=2 on Days 1, 8, and 15 every 28-day cycle (maximum 8 cycles). Endpoints were 1-year survival, tumor response, PFS, and safety. Among the 59 eligible patients, the 1-year survival was 28% and median survival was 6 months (range: 1-24.3). The median duration of response for CR+PR was 5.4 months (range: 2.3-9.7), 1-year progression-free survival was 14% (median of 3.7 months, range<1-22.8). Patients received a median of 3 cycles (range: 1-9); 14 patients (24%) had toxicity-related reductions. Responses were: 1 CR (2%), 5 PR (10%), 22 SD (45%), and 21 PD (43%). Forty-nine patients were evaluable for response; 10 patients were non-evaluable due to: radiotherapy (1), withdrew consent (3), insurance issues (1), and early toxicity (1 each; dyspnea, weakness, and rash), and other illness (2). Fifty-eight patients were evaluable for safety. The primary Grade 3 or 4 toxicities were neutropenia and fatigue (10% each), nausea (9%), dehydration (7%), and vomiting (5%). A 12% response rate (plus 45% SD) confirms the relatively poor outcome of patients with advanced NSCLC who are PS 2. Toxicities of docetaxel+carboplatin are comparable to other regimens and this combination may provide an alternative for this group of patients. Further studies correlating patient characteristics with response are necessary.

A phase II study of weekly docetaxel and carboplatin in stage IIIB (with effusion) or stage IV non-small cell lung cancer patients age &lt;65 and performance status 2

7276 Background: Primary goals of therapy for advanced non-small cell lung cancer (ANSCLC) are an increased survival time, palliation of symptoms, and prolonged time to progression (TTP). This study was designed to explore if ANSCLC patients (pts) with ECOG PS 2 and age ≤65 years could benefit from systemic chemotherapy with acceptable toxicities. Methods: Fifty-nine eligible pts with stage IIIB (effusion) or stage IV NSCLC were registered on study. Patients received docetaxel (Taxotere®) 35 mg/m2 and carboplatin AUC=2 on Days 1, 8, and 15 every 28-day cycle (maximum 8 cycles). Endpoints were 1-year survival, tumor response, TTP, and safety. Results: Among the 59 eligible pts, 1 never received study drug, 58 pts were evaluable for safety, and 49 for response; 9 pts were non-evaluable due to: palliative XRT (1), withdrawal of consent (2), toxicities (1 each; dyspnea, weakness, allergy to study drug) and other illness (3). Responses were: 1 CR (2%), 5 PR (10%), 22 SD (45%), and 21 PD (43%). The 1-year survival was 28%; median survival was 6.0 months (range, <1–24.3). The 1-year progression-free survival was 14% with a median TTP of 3.7 months (range, <1–22.8) and median duration of response for CR+PR was 5.4 months (range, 2.3–9.7). Patients received a median of 3 cycles (range, 1–9); 14 pts (24%) had dose reductions, mainly due to toxicities. The primary Grade 3 or 4 toxicities were neutropenia and fatigue (10.2% each), nausea (8.5%), dehydration (6.8%), and vomiting (5.1%). All 43 deaths were due to PD. Toxicities of this regimen are comparable to other chemotherapy regimens used in this population, thus it may be an alternative treatment choice for patients with ANSCLC who are ≤65 years and PS 2. Conclusions: These results confirm the relatively poor outcome of PS 2 pts with ANSCLC. The overall benefit of chemotherapy doublets, compared to monotherapy, in this patient population remains to be proven. Supported by Aventis Pharmaceuticals, Bridgewater, NJ No significant financial relationships to disclose.

A phase II study of weekly docetaxel and carboplatin in stage IIIB (with effusion) or stage IV non-small cell lung cancer patients age &lt;65 and performance status 2

7122 Background: Primary goals of therapy for advanced non-small cell lung cancer (ANSCLC) are an increased survival time, palliation of symptoms, and prolonged time to progression (TTP). This study was designed to explore if ANSCLC patients (pts) with ECOG PS 2 and age ≤65 years could benefit from systemic chemotherapy with acceptable toxicities. Methods: Fifty-nine eligible pts with stage IIIB (effusion) or stage IV NSCLC were registered on study. Patients received docetaxel (Taxotere®) 35 mg/m2 and carboplatin AUC=2 on Days 1, 8, 15 every 28-day cycle (maximum 8 cycles). Endpoints were 1-year survival, tumor response, TTP, and safety. Results: Among the 59 eligible pts, 1 never received study drug, 58 pts were evaluable for safety, and 49 for response; 9 pts were non-evaluable due to: palliative XRT (1), withdrawal of consent (2), toxicities (1 each; dyspnea, weakness, allergy to study drug) and other illness (3). Responses were: 1 CR (2%), 5 PR (10%), 22 SD (45%), and 21 PD (43%). The 1-year survival ...

A phase II study of weekly docetaxel and carboplatin in stage IIIB (with effusion) or stage IV non-small cell lung cancer patients age &lt; 65 and performance status 2

A phase II study of weekly docetaxel and carboplatin in stage IIIB (with effusion) or stage IV non-small cell lung cancer patients age &lt; 65 and performance status 2

A phase II study of weekly docetaxel and carboplatin in stage IIIB (with effusion) or stage IV non-small cell lung cancer patients age &lt; 65 and performance status 2

7122 Background: Primary goals of therapy for advanced non-small cell lung cancer (ANSCLC) are an increased survival time, palliation of symptoms, and prolonged time to progression (TTP). This study was designed to explore if ANSCLC patients (pts) with ECOG PS 2 and age ≤65 years could benefit from systemic chemotherapy with acceptable toxicities. Methods: Fifty-nine eligible pts with stage IIIB (effusion) or stage IV NSCLC were registered on study. Patients received docetaxel (Taxotere®) 35 mg/m2 and carboplatin AUC=2 on Days 1, 8, 15 every 28-day cycle (maximum 8 cycles). Endpoints were 1-year survival, tumor response, TTP, and safety. Results: Among the 59 eligible pts, 1 never received study drug, 58 pts were evaluable for safety, and 49 for response; 9 pts were non-evaluable due to: palliative XRT (1), withdrawal of consent (2), toxicities (1 each; dyspnea, weakness, allergy to study drug) and other illness (3). Responses were: 1 CR (2%), 5 PR (10%), 22 SD (45%), and 21 PD (43%). The 1-year survival was 28%; median survival was 6.0 months (range, <1–24.3). The 1-year progression-free survival was 14% with a median TTP of 3.7 months (range, <1–22.8) and median duration of response for CR+PR was 5.4 months (range, 2.3–9.7). Patients received a median of 3 cycles (range, 1–9); 14 pts (24%) had dose reductions, mainly due to toxicities. The primary Grade 3 or 4 toxicities were neutropenia and fatigue (10.2% each), nausea (8.5%), dehydration (6.8%), and vomiting (5.1%). All 43 deaths were due to PD. Toxicities of this regimen are comparable to other chemotherapy regimens used in this population, thus it may be an alternative treatment choice for patients with ANSCLC who are ≤65 years and PS 2. Conclusions: These results confirm the relatively poor outcome of PS 2 pts with ANSCLC. The overall benefit of chemotherapy doublets, compared to monotherapy, in this patient population remains to be proven. Supported by Aventis Pharmaceuticals, Bridgewater, NJ No significant financial relationships to disclose.

Etoposide phosphate with carboplatin in the treatment of elderly patients with small-cell lung cancer: A phase II study

Although the average age of lung cancer patients is increasing, many elderly patients remain undertreated, mainly because of the fear of higher treatment toxicity in this category of patients. We conducted a study to evaluate the efficacy and tolerability of a combination therapy with carboplatin (C) and etoposide phosphate (EP) in elderly patients with Small-Cell Lung Cancer (SCLC). Previously untreated patients older than 70 years with stage IIIB/IV SCLC received a combination of EP (100 mg/m2 D1, D2, D3) and C (D1, dose calculated according to the Calvert formula). Response rate, survival and toxicity were assessed. Thirty-eight patients (mean age 76 years, range 70-88 years) received a total of 162 cycles. Eighteen patients (47%) received the six scheduled cycles. Thirty patients were evaluable for efficacy (2 CR and 20 PR). The median survival was 237 days and the one-year probability of survival was 26%. The most common adverse effect was transient grade 3 or 4 neutropenia, observed during 57% of evaluable cycles, while five episodes of febrile neutropenia also occurred, with one fatal (bacteremia). It is noteworthy that no renal or liver toxicity was observed, and no mucitis was noted. Unfortunately, a relatively high proportion of patients died shortly after the start of the study. Although most deaths seemed unrelated to the treatment, the possibility of its exacerbatory effect on comorbidities, especially cardiovascular, cannot be excluded. The two-drug regimen of carboplatin and etoposide phosphate is feasible in most elderly patients with an acceptable toxicity, and the overall results suggest that patients even older than 70 years may benefit from full treatment. Therefore, consideration should be given to offering active treatment to most patients with SCLC, regardless of age but with special attention paid to comorbidities.

Prevalence of co-morbidity in lung cancer patients and its relationship with treatment: A population-based study

Background: With the rising mean age of lung cancer patients, the number of patients with serious co-morbidity at diagnosis is increasing. As a result, co-morbidity may become an important factor in both the choice of treatment and survival. We studied the prevalence of serious co-morbidity among newly diagnosed lung cancer patients and its association with morphology, stage and treatment. Patients: A total of 3864 lung cancer patients registered in the population-based registry of the Comprehensive Cancer Centre South between 1993 and 1995. Results: During the study period, the mean age of patients was 67 years (range: 29–93). The most frequent concomitant diseases were cardiovascular diseases (23%), chronic obstructive pulmonary diseases (COPD) (22%) and other malignancies (15%). The prevalence of concomitant diseases was highest for men (60%), patients with squamous-cell carcinoma (64%) and those with a localised tumour (66%). The resection rate for patients <70 years, with a localised non-small-cell lung tumour, was especially low for those with COPD (67%) or diabetes (64%) compared with patients without concomitant diseases (94%). The association between co-morbidity and chemotherapy for patients with small-cell lung cancer was limited. Conclusions: The prevalence of co-morbidity, especially cardiovascular diseases and COPD, among lung cancer patients is about twice as high as in the general population. Co-morbidity seems to be associated with earlier diagnosis of lung cancer, but it may also lead to less accurate staging and less aggressive treatment. Thus, prognosis is likely to be negatively influenced by co-morbidity.