CHICAGO — Older patients receiving concurrent chemoradiotherapy for stage III non-small cell lung cancer (NSCLC) had worse overall survival but similar progression-free survival as compared with younger patients, new data presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting suggest.1
“Patients with unresectable stage IIIA and stage IIIB NSCLC, a performance status of 0 or 1, and adequate organ function are candidates for concurrent chemoradiotherapy with curative intent,” lead investigator Thomas E. Stinchcombe, MD, co-director of the multidisciplinary thoracic oncology program at UNC Lineberger Comprehensive Cancer Center in Chapel Hill, NC, told Cancer Therapy Advisor. “However, elderly patients are underrepresented in clinical trials and subset analyses of elderly patients from the individual trials are frequently limited by sample size.”
Because clinicians have doubts about the ability of older patients to benefit from or tolerate concurrent chemoradiotherapy, researchers sought to compare outcomes between older and younger patients undergoing concurrent chemoradiotherapy for stage III NSCLC.
For the study, investigators analyzed pooled data from 2337 patients younger than 70 years and 733 patients aged 70 or older with stage IIIA/IIIB disease who participated in 15 cooperative group phase 2 or 3 trials of concurrent chemoradiotherapy between 1990 and 2012.
After adjusting for confounding factors, results showed that older patients had a 17% higher risk of death compared with younger patents (adjusted HR, 1.17; 95% CI, 1.05-1.30; P=.0006). In contrast, older and younger patients had similar progression-free survival (adjusted HR, 1.05; 95% CI, 0.95-1.16; P=.4100).
“Elderly compared to younger patients had a statistically significant worse overall survival and similar progression-free survival,” Dr Stinchcombe noted.
In terms of safety, older patients reported a higher incidence of grade 3 or worse non-hematologic adverse events than younger patients (66% vs 59%; P<.05) and older patients more frequently experienced grade 5 adverse events (7.6% vs 3.8%; P<.05).
“Specific grade 3 or worse adverse events were higher among elderly patients, and investigations to prevent these adverse events among elderly patients would improve clinical care,” Dr Stinchcombe said.
Further, the study demonstrated that a lower percentage of older patients completed therapy compared with younger patients (49% vs 59%; P<.05) and a higher percentage of older patients discontinued therapy due to toxicity (20% vs 14%; P<.05). Older patients also were more likely to refuse further treatment, develop another disease, and die during therapy (all P<.05).
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However, there was no significant difference in treatment-related death between the 2 age groups (P=.12).
“Prospective assessment of elderly patients and comorbidities and geriatric comprehensive assessment on clinical trials would better define this heterogeneous patient population,” Dr Stinchcombe concluded.
- Stinchcombe T, Zhang YJ, Vokes EE, et al. A pooled analysis of concurrent chemoradiotherapy (CCRT) for patients with stage III non-small cell lung cancer (NSCLC) who participated in U.S. cooperative group trials: Comparing the outcomes of elderly to younger patients (pts). J Clin Oncol. 2016; 34 (suppl; abstr 8508).