New study questions concurrent treatment options for elderly lung cancer patients

Elderly people with lung cancer are less likely to benefit from simultaneous radio- and chemotherapy treatment than younger patients, a new study suggests.

New research about lung cancer treatment
A study is questioning the benefits of simultaneous radio- and chemotherapy treatment for elderly lung cancer patients

The trial at the MAASTRO Clinic in The Netherlands involved 300 patients, 25.3 per cent of which were aged 75 or older with 96 per cent of them classed as being fully active and able to carry on a normal life*.

32 per cent received concurrent chemo-radiotherapy, 29 per cent sequential chemo-radiotherapy (chemotherapy followed by radiotherapy) and 39 per cent radiotherapy alone.

The overall survival rate for elderly patients receiving simultaneous radio- and chemotherapy was 15.5 months compared to 19.8 months for their younger counterparts. After five years, 13.2 per cent of elderly patients were alive compared to 24.1 per cent of younger patients.

There were little differences within age groups for those receiving sequential chemo-radiotherapy or radiotherapy alone.

"A person’s quality of life is the most important thing. People having radio- and chemotherapy can suffer from severe side effects and, so far, we didn’t know if concurrent treatment improved survival in over 75s, or how they would tolerate the treatment. The last thing we want is for people to suffer needlessly"
Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation

Dr. Judith van Loon is a radiation oncologist at the MAASTRO Clinic:

“We found that elderly patients who were treated with concurrent chemo-radiotherapy had a worse survival than younger patients, they also did worse than the elderly patients treated with sequential chemo-radiotherapy or radiotherapy alone. Furthermore, it was not possible to increase the dose to the tumour without increasing the chance of side effects.

“These results indicate that the standard treatment for lung cancer patients may not result in the best outcomes for elderly patients. Most importantly, they show that selecting elderly patients for concurrent chemo-radiotherapy on the basis of their performance score is not sufficient.

“These findings underscore the need for prospective studies that incorporate geriatric assessment in this understudied group of elderly cancer patients, as this enables us to identify predictive factors for treatment outcome. Also, we should look not only at the chance of cure but also quality of life and patient-reported outcome measures. This can help physicians to select the best treatment for individual patients.”

These results challenge previous research which showed radiotherapy given at the same time as chemotherapy gave patients with locally advanced non-small cell lung cancer the best chance of survival, compared to a treatment plan where chemotherapy was given first.

Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, comments:

“A person’s quality of life is the most important thing. It is why we welcome this latest study and fund research into this somewhat neglected field.

“People having radio- and chemotherapy can suffer from severe side effects and, so far, we didn’t know if concurrent treatment improved survival in over 75s, or how they would tolerate the treatment.

“The last thing we want is for people to suffer needlessly so are eager for further investigation and the results of this ongoing study.

“Our research fellow at the University of Nottingham, Dr Gavin Jones, is also looking at the impact of chemotherapy and radiotherapy. We want patients to have as much information about their treatment as possible so they can decide if they want to go ahead or instead choose to have palliative care.”

"This analysis demonstrates that one size does not fit all when it comes to treating cancer patients of different ages."
Professor Yolande Lievens, president of ESTRO and head of the department of radiation oncology at Ghent University Hospital, Belgium

The trial will be presented at the ESTRO 37 conference tomorrow in Barcelona. The conference aims to give radiation oncologists, medical physicists, radiobiologists, brachytherapists and radiation therapists (RTTs) the opportunity to engage with other oncology organisations with the collective aim of improving cancer treatment.

Professor Yolande Lievens, president of ESTRO and head of the department of radiation oncology at Ghent University Hospital, Belgium looks forward to the presentation:

“This analysis demonstrates that one size does not fit all when it comes to treating cancer patients of different ages. Elderly people, even when they are otherwise fit and healthy, respond differently to treatments than their younger counterparts. More research needs to be performed to define the most effective treatment strategies for these patients that do not impact on their quality of life without improving survival.

“We look forward to the results from the multi-centre trial that is investigating a more personalised and tailored approach and assesses the value of a more intensive treatment strategy in the elderly patient population with non-small cell lung cancer.”

*Based on a World Health Organisation (WHO) performance score of 1 or less.

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