Jan 04, 2016
By Shira Klapper, Senior Writer/Editor
Among older patients (age 70 and over) with limited-stage small cell lung cancer (LS-SCLC), clinical stage I to III, those who receive combined-modality treatment of both chemotherapy plus radiation have a median overall survival (OS) of 15.6 months, compared to 9.3 months among older patients who receive chemotherapy alone. At the three-year mark, 22% of older patients who received chemoradiotherapy (CRT) were alive, compared to 6.3% among those who received chemotherapy alone. That’s according to a new Journal of Clinical Oncology (JCO) article, “Role of Chemoradiotherapy in Elderly Patients With Limited-Stage Small-Cell Lung Cancer,” which looked at 8,637 older patients with LS-SCLC. The study, published online, ahead of print, October 19, also found that the survival advantage of receiving CRT held up among patients 80 years and over and among those with multiple medical comorbidities.
In addition to CRT, higher OS among patients 70 years and older was associated with the following characteristics: age younger than 80, female sex, Charlson-Deyo score of 0, clinical stage I disease, and receipt of non–single-agent CT. In addition, the data from the study showed that among patients who were alive four months after diagnosis, those who received concurrent CRT survived 2.4 months longer than those who received sequential CRT.
Commenting on these findings, the study’s first author, Christopher D. Corso, MD, PhD, said, “Patients over the age of 70 make up approximately 45% of all limited stage small cell lung cancer patients. Our findings support the idea that at the very least, these patients warrant consideration for chemotherapy and radiation as the primary intervention for LS-SCLC, while also taking into account other factors such as performance status and medical co-morbidities.”
The controversy around combined modality treatment for older patients
Giving both chemotherapy and radiation to older patients with LS-SCLC is a controversial topic. Studies have shown that patients with LS-SCLC who receive combined-modality treatment have a definite survival advantage compared with patients who receive chemotherapy only, and national comprehensive cancer network guidelines suggest that patients with a good performance status should be treated with four to six cycles of chemotherapy and radiation. However, previous studies did not assess whether the survival advantage of CRT also held up for older patients—a population that is at higher risk of developing toxicities from chemotherapy and radiation.
This concern about toxicity—combined with findings from a previous study showing that older people with LS-SCLC who received combined-modality treatment had a trend towards a survival disadvantage, compared to those who received chemotherapy alone— has led to some concern among clinicians about giving CRT to older patients.
While this current study in JCO did not assess toxicity, it used OS as a proxy for adverse events; the researchers worked with the assumption that had CRT led to high-grade toxicity, they would have likely seen lower survival rates than they actually observed.
“I think that with this study, which included 8,500 patients and is the largest of its kind, we have shown a potential survival benefit with the use of the combined modality treatment for elderly patients.” said Dr. Corso.
Christopher D. Corso, MD, PhD, is a Resident in the Department of Therapeutic Radiology at Yale School of Medicine in New Haven, Connecticut.
Abstract of the original JCO article.
PDF of the original JCO article.
Corso CD, Rutter CE, Park HS, et al. Role of chemoradiotherapy in elderly patients with limited-stage small-cell lung cancer. J Clin Oncol. Epub 2015 Oct 19.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO, JOP, and JGO, with additional perspective provided by the lead or corresponding author.
@ 2016 American Society of Clinical Oncology