ASCO: Any Age Is Okay for Adjuvant Chemotherapy for Early Lung Cancer

ATLANTA, June 3 ? Older age is no barrier to platinum-based adjuvant chemotherapy for early-stage non-small-cell lung cancer (NSCLC), researchers reported here.

And even when elderly patients can't tolerate maximum doses of chemotherapy, they still derive a substantial survival benefit, said Carmela Pepe, M.D., of Princess Margaret Hospital in Toronto in a presentation at the American Society of Clinical Oncology meeting here.

"At five years, the survival rate for patients over age 65 who had adjuvant chemotherapy with Navelbine (vinorelbine) and Platinol (cisplatin) was 66%, versus 46% for same-age patients who had only surgery," she said.

The difference was significant (P=0.04), which was not the case for patients under age 65 in whom the 70% survival for patients who had adjuvant chemotherapy was not significantly greater than the 58% five-year survival posted by surgery patients (P=0.14).

Disease-specific survival at five years was 73% for older patients who had chemotherapy following surgery versus 56% for those who had surgery alone (P=0.13). In younger patients disease-specific survival was significantly better for younger patients with adjuvant chemotherapy-72% versus 60% (P=0.05).

Her study was a retrospective review of the toxicity and survival benefits for 327 patients ages 65 or younger and 155 patients older than 65, who were enrolled in the National Cancer Institute of Canada Clinical Trials Group and Integroup Study JBR-10.

Baseline prognostic factors were similar among the two age groups, with the exception of histology. The older patients were more likely to have andenocarcinomas, while the younger patients were more likely to have squamous-cell carcinomas.

There were no significant differences in toxicities, she said, except for myalgias and mood alteration, which was observed more frequently in the younger patients.

But no older patient completed the full 16-dose Navelbine regimen and only 31.8% received the recommended eight doses of Platinol, which was significant P=0.014 for Navelbine and 0.006 for Platinol, compared with younger patients.

So it followed that the dose intensity was significantly less among the older patients-13.2 for younger patients versus 10.0 for older patients taking Navelbine (P=0.0004) and 18.0 versus 14.1 for those taking Platinol (P=0.001), she said.

She said older patients were more likely to refuse treatments and they were also more likely to "have co-morbidities that caused them to stop treatment."

But the study showed, she said, "that even a little bit of chemotherapy is very beneficial in these patients."

Thoracic surgeon Yolanda L. Colson, M.D., of Brigham and Women's Hospital in Boston said Dr. Pepe's results confirm "that we shouldn't make treatment decisions based on age alone."

Dr. Colson moderated an ASCO press briefing where Dr. Pepe discussed her results.