Treating older patients with advanced lung cancer on the basis of comprehensive geriatric assessments carried no survival advantage over performance status and age, according to a large European study.1 However, using these multidisciplinary assessments prior to chemotherapy resulted in fewer adverse side effects.
In this phase 3 trial, nearly 500 patients with stage 4 non-small cell lung cancer were randomly assigned to receive either chemotherapy based on performance status and age, or to chemotherapy based on scores from comprehensive geriatric assessments (CGA). Median age in the open-label, multicenter trial at 45 centers in France and Spain, was 77.
“In a non-curative setting such as this, you want to minimize toxicity, so this is important” Stuart Lichtman, MD, FACP, an attending physician and member, Memorial Sloan Kettering Cancer Center in New York, NY, told Cancer Therapy Advisor. Lichtman, who serves on the elderly cancer committee of the Alliance for Clinical Trials in Oncology, praised the investigators for designing the trial and said that accruing 494 patients so quickly between 2010 and 2013, was a “testament to their dedication and a monumental feat.”
Even though there was no improvement in survival, he said, the large amount of data generated by the study can be used in other ways, beyond its therapeutic findings, in the future.
In the standard arm of the trial, older patients under age 75, with a performance status of less than 1, or unable to do strenuous activities, received 2 carboplatin-based drugs. Those over 75 years or with a slightly worse performance status of 2, received just 1 chemotherapy drug, docetaxel.
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Similarly, in the CGA arm, the most fit cancer patients with the best CGA scores also received 2 carboplatin-based drugs, while vulnerable patients received docetaxel alone and the frailest patients—about 24% of those enrolled in this arm—received best supportive care only.
The primary endpoint of the trial was treatment failure-free survival, defined as the time elapsing between random trial assignment and early treatment discontinuation as a result of any reason, including disease progression, treatment toxicity, or early death.