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Guest column

Fit, older lung cancer patients respond to chemotherapy

By V. UPENDER RAO
Published December 19, 2005

The Geriatric Oncology Consortium, which deals with cancer in the older patients, recently met in Washington, D.C. One issue discussed was chemotherapy in older patients for nonsmall-cell lung cancer.

Rodrigo B. Erlich, co-director of the consortium, said the fit older patients should be treated like younger patients despite increased toxicity. Several other physicians echoed his recommendations.

They mentioned that, although robust phase III clinical trial data is not available, retrospective data on nonsmall-cell lung cancer patients age 70 and older who are enrolled in major clinical trials - as well as meta analytical data from trials that included older patients - indicate that fit older patients have the same response and survival rates as younger patients.

They may experience more short-term toxicity. but good modern supportive care measure can alleviates these. New targeted therapeutic agents such as Iressa and Tarceva (and other similar targeted agents) which could be very effective in selected patients, while being less toxic, may become more prevalent in the nonsmall-cell lung cancer treatment in the future.

Avastin, an antiangiogenesis drug, is one such targeted agent recently approved by the FDA for colon and lung cancers.

Other nonchemotherapeutic targeted agents in the pipeline for nonsmall-cell lung cancer include Velcade (proteosome inhibitor), Thalidomide (antiangiogeogenic), and Telcita (glutathione analogue). Telcita in particular is of interest in that it has produced a response rate of 63 percent in combination with standard chemotherapy for nonsmall-cell lung cancer in phase II clinical trials.

Initial data indicates that this agent has very little toxicity of its own and can be used for prolonged period for maintenance of remission. Telcita is currently available at the Cancer and Blood Disease Center for recurrent ovarian cancer on a prospective randomized clinical trial.

Although cancer is more prevalent in older patients, very few are enrolled in clinical trials. To find the ideal treatments for older patients, it is imperative that they be systematically studied on randomized clinical trials. The oncology community has to do a better job in convincing the referring physicians that this is an important issue.

At the same consortium meeting, Thomas Bilfinger, M.D., ScD chief of thoracic surgery at the State University of New York-Stony Brook, said "lung cancer surgery can be successful in older patients as it is in younger patients, if meticulous attention is paid to certain details."

He also said, "With this careful patient evaluation and selection procedure, age should be a simple scientific fact rather than a source of fear or discrimination in patient management."

Age is of special importance in lung cancer because the majority of patients are older than 65 and as the U.S. population ages, and the absolute numbers of lung cancer patients will rise dramatically. It is therefore better to offer existing, effective and approved treatments and to enroll older patients in clinical trials to develop safer and more effective treatments.

--V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified December 19, 2005, 01:38:18]