Age-Specific Sub-Analysis of ECOG 1594: Fit Elderly Patients (70-80 yrs) with Non-Small Cell Lung Cancer Do As Well As Younger Patients (<70 yrs)

Reviewer: S. Jack Wei, MD
OncoLink
Last Modified: May 31, 2003

Presenter: CJ Langer
Presenter's Affiliation: Fox Chase Cancer Center
Type of Session: Poster

Background

Exclusion of elderly patients from studies of advanced non-small cell lung cancer (NSCLC) has been common due to fear of increased toxicity of platinum-based regimens in these patients. Previous retrospective studies have been mixed regarding the impact of age on patient outcome and toxicity. ECOG 1594 was previously published and compared four "state-of-the-art" chemotherapy regimens for advance NSCLC. This study retropectively compared the outcomes of elderly (70 yrs or older) patients to younger patients (less than 70 yrs) in ECOG 1594.

Materials and Methods

The four arms of the the original study consisted of: 1) cisplatin + paclitaxel q3wks 2)cisplatin + gemcitabine q4wks 3) cisplatin + docetaxel q3wks 4) carboplatin + placlitaxel q3wks.
A retrospective sub group analysis of patients <70 yrs versus patients >=70 was performed on the patient population in ECOG 1594.
227/1139 eligble patients were >=70 yrs, 9 patients were >=80 yrs

Results

Demographics were similar for those <70 yrs and those >=70 yrs.
There was no difference between the two age groups based for number of patients completing all 6 cycles of chemotherapy, median number of cylces completed, response rate, 1-yr progression-free survival (PFS), 1-yr overall survival (OS), or 2-yr OS
There was a difference for those <70 vs. those >=70 for 2-yr PFS (0.5% vs 2.2%, respectively, p=0.04) and for grade 4 or higher toxicity (60% vs. 71.2%, p=0.04) which mainly consisted of myelosuppression
There was no difference between age groups when analyzed by treatment arms
Patients >=80 yrs fared worse with 0/9 completing 6 cycles and an overall response rate of 0%.

Author's Conclusions

Fit elderly patients fared as well as younger patients with similar overall response rates, PFS, and OS.
Elderly patients did have an increased rate of toxicity, particularly myelosuppression
Patients >=80 yrs did poorly, although the number of patients was too small to draw broad conclusions for this age group.

Clinical/Scientific Implications

The results of this sub group analysis support the inclusion of fit elderly patients in studies for advanced NSCLC. Although outcome measures were similar for elderly patients, they did experience a higher rate for treatment-related toxicity; therefore, careful pharmacokinetic assessments must be made for elderly patients enrolling in these studies. Patients >=80 yrs need to be studied separately to determine the appropriateness of including these patients in future studies.

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