Elderly Lung Cancer Patients Should be Considered for Salvage Targeted Therapy
Elderly patients with NSCLC are commonly undertreated because of toxicity concerns, noted Anne S. Tsao, MD, of the Department of Thoracic/Head & Neck Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston, and coauthors.
But “fit elderly NSCLC patients should be considered for salvage targeted therapy,” the authors concluded.
“The clinical outcome results of our sex- and treatment-specific analyses were surprising, with elderly men having both improved DCR (disease-control rate) and PFS (progression-free survival) compared with younger men,” the authors noted. “In particular, older men benefitted from sorafenib, and a positive association between EGFR wild-type and KRAS mutation phenotypes, and sorafenib benefit has previously been reported by this group and others.”
The team studied biomarker and clinical outcome data for 255 patients with chemorefractory NSCLC, enrolled in the BATTLE (Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination) trial. Elderly patients experienced more diarrhea and gastrointestinal complaints than other patients, the authors found.
Overall response rates did not differ by age or sex. Patients older than 65 years had superior DCR (55.4% vs 40%; P=0.02), and this finding was stronger among men (62% vs 38%; P=0.008), the authors noted. The 8-week DCR rate was strongest among men aged older than 70 years (64% vs 43%; P=0.04).
“The only treatment that showed a DCR difference by age or sex was the erlotinib monotherapy arm, in which treated men aged 70 years or more had a higher DCR than younger men did (67% vs 26%, P=0.05),” the authors wrote.
There were no statistically significant differences in OS between patients of different ages.
But “similar to the DCR findings, sex-age subgroup analysis demonstrated that men aged 65 or more had a better median PFS compared with younger men (2.8 months vs 1.8 months, P=0.0068),” they reported.
Elderly women had worse PFS with vandetanib (but no difference in overall survival), the authors noted – a finding that was not explained by poor compliance or dose-reductions.