Elderly Advanced Non-small Cell Lung Research Articles

The Role of Immunotherapy in the First-Line Treatment of Elderly Advanced Non-Small Cell Lung Cancer

Immune checkpoint inhibitors have changed the history of NSCLC treatment by becoming, alone or in combination with platinum-based chemotherapy, a mainstay of first-line therapy for advanced NSCLC. This increasingly dictates the identification of predictive biomarkers of response that can guide patient selection, in order to rationalize and personalize therapies, particularly in elderly patients. Immunotherapy in these patients raises questions of efficacy and tolerability related to aging, which is accompanied by a progressive decline in various body functions. Physical, biological and psychological changes contribute to individual validity status and, preferably, ‘fit’ patients are generally enrolled in clinical trials. In elderly patients, especially frail and complex patients with more than one chronic disease, data are poor and specific prospective studies are needed. This review reports the main available results on the use of immune checkpoint inhibitors in older patients with advanced NSCLC, in terms of efficacy and toxicity, and aims to highlight the need to better predict which patients might benefit from immunotherapy agents by probing knowledge and integrating information on immune system changes and age-related physiopathological modifications.

Clinical effect of icotinib in treatment of elderly advanced non-small cell lung cancer patients with EGFR mutations

Clinical effect of icotinib in treatment of elderly advanced non-small cell lung cancer patients with EGFR mutations

Serum albumin level as a potential marker for deciding chemotherapy or best supportive care in elderly, advanced non-small cell lung cancer patients with poor performance status

BackgroundThere have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear. The objective of this study was to identify factors that predicted the survival benefit of chemotherapy.MethodsAll consecutive elderly patients (≥75 years) with advanced NSCLC, Eastern Cooperative Oncology Group PS ≥2, EGFR mutation wild type/unknown, and newly diagnosed from January 2009 to December 2012 at a tertiary hospital were retrospectively reviewed.ResultsWe enrolled 59 patients, and 31 patients received at least one chemotherapy regimen (chemotherapy group). However, 28 patients received best supportive care (BSC) alone (BSC group). The proportion of PS 2 and serum albumin levels was significantly higher in the chemotherapy group than in the BSC group. In the chemotherapy group, log-rank testing did not show statistically significant differences in overall survival (OS) between the single-agent therapy group and carboplatin-based doublet therapy group; however, the OS of patients receiving chemotherapy for only 1 cycle (early termination) was significantly shorter than patients receiving chemotherapy for ≥2 cycles. Hypoalbuminemia was not only a risk factor for the early termination of chemotherapy but also an independent prognostic factor in the chemotherapy group. A receiver operating characteristic curve analysis showed that the best cut-off value was 3.40 g/dL. In patients with serum albumin levels ≥3.40 g/dL, OS was significantly better in the chemotherapy group than in the BSC group (p = 0.0156), however, patients with serum albumin levels <3.40 g/dL exhibited poor prognosis regardless of the presence or absence of chemotherapy.ConclusionIn the elderly NSCLC patients with poor PS, serum albumin levels may help identify certain patient populations more likely to receive a survival benefit of systemic chemotherapy.

Clinical observation of body-gamma knife combined with recombinant human endostatin injection (Endostar) as the therapy in the elderly patients with advanced non-small cell lung cancers

Objective To explore the efficacy and safety of human recombinant vascular endothelial inhibition (en) combined with gamma knife in the treatment of elderly advanced non-small cell lung cancer patents. Methods Totally 38 cases of senile non-small cell lung cancer patients were divided into two groups: A group was treatment group with 17 cases of recombinant human endostatin combined with gamma knife, group B was control group with 21 cases of patients receiving body gamma knife alone. Recombinant human endostatin was given intravenously 15 mg per day in 500 ml of saline for 3~4 hours for 14 days a cycle, and the total dose of body gamma knife therapy was 36~48 Gy/10~12f. Results The response rate (RR) of groups A and B were 58.82% and 57.14% without statistical difference. One-year survival rate of groups A and B were 47.06% and 38.09%, respectively; and there was no statistical significance. The main side-effects of both groups were bone marrow suppression and gastrointestinal reactions, but no statistical difference was observed. Two groups of patients' quality of life were improved without statistical difference (P>0.05). Conclusions Body-gamma knife therapy combined with recombinant human endostatin in elderly advanced non-small cell lung cancer patients has better efficacy such as CR rate and long-term survival, and similar side-effects. Key words: Radiosurgery; Endostatins/TU; Carcinoma, non-small-cell lung/TH

Reasonable Choices for Cytotoxic or Cytostatic Treatment in Elderly Advanced Non-Small Cell Lung Cancer Patients

Reasonable Choices for Cytotoxic or Cytostatic Treatment in Elderly Advanced Non-Small Cell Lung Cancer Patients

Reasonable Choices for Cytotoxic or Cytostatic Treatment in Elderly Advanced Non-Small Cell Lung Cancer Patients

Copyright: © 2015 Zarogoulidis K . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Nowadays, expansion of the aging population, especially in developed countries, elderly lung cancer cases show an increasing trend. Surveillance Epidemiology and End Results (SEER) program data show that patients ≥ 70 years and older account for 47% of all lung cancer [1]. According to National Institute on Aging (NIA) and NCI SEER Collaborative Study on Comorbidity and Cancer in the Elderly, in the USA in 2030, 1 in 5 Americans will be aged ≥ 65 years [1].

Progress of non-small cell lung cancer in the elderly patients

At present,there is no unified standards of treatment in elderly advanced non-small cell lung cancer (NSCLC),but to elderly patients with higher KPS scores,radiotherapy or chemotherapy alone has gradually become the main treatment measures.The concurrent chemoradiotherapy can benefit to part of the elderly patients,and it is worth further clinical research.Targeted therapy has exactly effect,and the adverse effect is mild,which provides a new treatment model for elderly advanced NSCLC patients.However,the hospital costs are relatively high,which can not be accepted by ordinary family.So targeted drugs and the model of combination treatment can not be applied extensively. Key words: Carcinoma, non-small-cell lung; Aged

O2-020 - Carboplatin and Pemetrexed Followed by Pemetrexed for Elderly Advanced Non-Small Cell Lung Cancer Patients without Chemotherapy, Multi-Center, Phase I/II Trial

ABSTRACT We present the rationale and study design of the phase I and II trials of carboplatin plus pemetrexed followed by pemetrexed, which the multicenter trial on safety and efficacy of first-line therapies in elderly (75 years old or more) advanced non-small-cell lung cancer (NSCLC) patients. Treatment consists of up to four cycles of induction therapy followed by maintenance therapy until disease progression or treatment discontinuation in 3–6 patients/cohort (Phase I), and 34 patients (phase II). The primary end points of the present study are to determine the recommended dose (RD) and maximum tolerance dose (MTD) of carboplatin plus pemetrexed in phase I, and, in phase II, the efficacy objectives are to assess the 1-year survival rate, the overall survival (OS), response rates, progression-free survival (PFS). In addition, safety will be investigated in phase II study. If the primary objective (recommended dose and 1-year survival rate) is achieved, this study will provide robust results on an alternative treatment option, carboplatin plus pemetrexed followed by maintenance therapy with pemetrexed, for patients with elderly (75 years old or more) advanced nonsquamous NSCLC.

1285P - Biweekly Carboplatin and Paclitaxel as First-Line Therapy for Elderly Advanced Non-Small Cell Lung Cancer Patients (Phase II Study)

ABSTRACT Background Incidence of elderly patients with advanced non-small cell lung cancer (NSCLC) is increasing, however the treatment for elderly patients is still waiting for the best answer. Although several studies had suggested the advantage of chemotherapy with platinum doublet for elderly patients with advanced NSCLC (e.g. Quoix E, et al., The Lancet 378, 2011), the application of platinum doublet to the elderly is still controversial. To evaluate the efficacy and tolerability of combination chemotherapy with biweekly carboplatin (CBDCA) and paclitaxel (PTX) for elderly patients with advanced NSCLC, we conducted a multicenter non-randomized open label phase II trial. Methods Eligibility criteria were as follows; histologically proven NSCLC, aged 70 years and older, ECOG Performance Status (PS) of 0 to 2, clinical stage IIIB and IV, chemotherapy naive, and adequate organ function. Patients received CBDCA (AUC = 2.5) and PTX (90 mg/m2) on day 1 and 15 every 4-week for up to 6 cycles, until disease progression or intolerable toxicity. The primary endpoint was ORR, and the secondary endpoints were PFS, OS and tolerability. Results 60 patients (median age 78 years old, range 70-85) were enrolled. 45 patients were male and 45 were stage IV. PS 0/1/2 were 26/30/4, respectively. The median number of treatment cycle was 3 (1-6). CR/PR/SD/PD were 0/28.9/37.8/33.3% as the best response, giving an ORR of 28.9 % and DCR of 66.7%. Median PFS and OS were 5.3 month (95% CI: 3.1-7.5) and 26.7 month (95% CI: 18.2-35.1), respectively. Grade 3/4 hematological toxicities were neutropenia (27%), leucopenia (15%) and anemia (8%). Grade 3 non-hematological toxicities were infusion reaction (2%), anorexia (2%), infection (10%), thrombosis (2%), fatigue (3%), diarrhea (2%) and gastrointestinal bleeding (3%). Although no grade 4 non-hematological toxicity was observed, one patient died probably due to treatment-related interstitial pneumonitis. The adverse events were relatively mild and manageable. Conclusions The combination of biweekly CBDCA (AUC = 2.5) and PTX (90 mg/m2) was effective and well tolerated for elderly patients with advanced NSCLC. (This study was registered at UMIN 000001328) Disclosure All authors have declared no conflicts of interest.

Phase II study of biweekly carboplatin and paclitaxel as first-line treatment for elderly patients with advanced non-small cell lung cancer.

e18013 Background: Incidence of elderly advanced non-small cell lung cancer (NSCLC) is increasing and the establishment of optimal treatment for the elderly patients is desired. Currently, as the elderly are underrepresented in clinical trials, only limited data exist. Standard chemotherapy by platinum doublet of elderly patients with advanced NSCLC is still controversial. This study has been conducted to assess the efficacy and toxicity of biweekly carboplatin plus paclitaxel in elderly patients with advanced NSCLC. Methods: Patients ≥70 years old with cytological or histological confirmation of advanced (stage IIIB/IV) NSCLC were included. Other eligibility criteria were PS≤2, measurable lesions according RECIST criteria, adequate organ function. Patients with prior systemic therapy for NSCLC and/or symptomatic brain metastases were not allowed. Patients received biweekly paclitaxel 90 mg/m2 and carboplatin 2.5 AUC on days 1 and 14 of each 28-day cycle. The primary endpoint was the overall response rate (ORR), and secondary endpoints were progression-free survival (PFS), overall survival, and the toxicity profile. Results: We enrolled 47 pts from multiple institutions (Jan. 2007 – Oct. 2010). Males were 76.6%, median age was 77 years (range 70-85). PS was 0-1 in 95.7%. The median number of treatment cycle was 3 (1-6). The objective responses were CR 0; PR 10; SD 12; PD 14; and NE 11, resulting in an ORR of 21.3% (95% confidence interval [CI], 9.6- 33.0). The overall disease control rate was 46.8% (95% CI, 32.5-61.1). Median PFS was 4.17 month (95% CI: 2.18- 6.16). Hematological toxicities of grade 3/4 included neutropenia (28%), leucopenia (19%) and anemia (11%). Nonhematological toxicities (all grade 3) included infusion reaction (2%), anorexia (2%), infection (13%), thrombosis (2%), fatigue (2%), diarrhea (2%) and gastrointestinal bleeding (2%). No grade 4 nonhematological toxicity was observed. There was 1 possible treatment-related death due to interstitial pneumonia. Conclusions: The combination of biweekly carboplatin and paclitaxel is an active first line treatment with a tolerable toxicity profile for advanced NSCLC in elderly patients.

Weekly Paclitaxel and Cisplatin in the Treatment of Elderly Advanced Non-small Cell Lung Cancer.

Lung cancer is one of the most common cancers in the world. The number of elderly lung cancer patients is expected to rapidly increase. Therefore, the management of elderly lung cancer patients is becoming a major challenge in the field of oncology. This study was to evaluate the efficacy and safety of weekly paclitaxel (PTX) and cisplatin (DDP) as the first-line chemotherapy on advanced NSCLC patients of more than 70 years old. Fifty chemotherapy-naive patients with advanced NSCLC more than 70 years old were administrated weekly paclitaxel and pisplatin regiment: PTX 80 mg/m(2) intravenous infusion for 1 h, d1, d8 (given routine premedications before PTX), DDP 20 mg/m(2) intravenous infusion, d1, d8, every 21 days. Total 50 patients were enrolled, and 48 patients were evaluable for response. The ORR (overall response rate) was 39.6%; median survival time (MST) was 14.8 months; One year survival rate was 58.3%. Most common adverse events were leucopenia (60%), anemia (62%), nausea and vomiting (30%), alopecia (100%). There were no chemotherapy-related deaths. The patients of advanced NSCLC more than 70 years old can tolerate weekly paclitaxel and cisplatin and can get benefit from this regiment.