Fit elderly patients with NSCLC should be considered for therapy

Fit elderly patients with non-small cell lung cancer (NSCLC) should be considered for salvage targeted therapy. Many physicians use age to decide what therapy to give their patients, since validated biomarkers to direct treatment decisions are lacking. Older patients often go undertreated because of concerns about their limited tolerance to toxic therapies.

This study analyzed data from 255 patients with NSCLC who were involved in the Biomarker-Integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) trial. This analysis compared patient subgroups who were age 65 years and older versus those younger than 65 years, and also patient subgroups who were age 70 years and older versus those younger than 70 years.

The overall response rate did not differ between any age group or sex, and the progression-free survival rate did not differ by age group. Elderly men had both an improved disease control rate at 8 weeks and improved progression-free survival compared with younger men. The overall survival of elderly men age 70 years and older who were treated with sorafenib was higher than that of younger men. Unfortunately, the progression-free survival of women age 70 years or older was worse than that of younger patients.

Regarding toxicity, the researchers found that the incidence of pneumothorax did not increase in patients older than 65 years. Among women age 65 years or older, more grade 3 or 4 nonhematologic toxicities occurred.

Notably, the elderly patients in BATTLE did experience “more nonhematologic toxicities, primarily diarrhea and gastrointestinal complaints, but they were able to undergo diagnostic core needle biopsies and subsequent targeted therapy treatment without increased incidence of pneumothorax or treatment-related mortality,” according to the study's authors.

The authors concluded that sex and age variations exist for tumor biomarker analysis. Certain agents seem to give a clinical benefit to older men. Elderly patients with NSCLC who are fit should be considered for salvage targeted therapy.

This study was published in Journal of Thoracic Oncology (2012;7[11]:1645-1652).

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