Do elderly patients (pts) with locally advanced non-small cell lung cancer (NSCLC) benefit from combined modality therapy? a secondary analysis of RTOG 94-10

Langer, Corey J.; Hsu, Chun-Yao; Curran, Walter J.; Komaki, Ritsuko; Lee, J.S.; Byhardt, Roger W.; Sause, William T.

doi:10.1016/s0360-3016(01)01860-0

Cited by 86 publications

(70 citation statements)

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“…However, in a later study, Langer et al 22 found that fit elderly patients did seem to benefit from concurrent chemotherapy and qd RT. They evaluated the outcomes of patients Ն 70 years who were enrolled in RTOG protocol 94-10.…”

Section: Discussionmentioning

confidence: 92%

“…Researchers at both the Radiation Therapy Oncology Group (RTOG) and the Cancer and Leukemia Group B (CALGB) examined groups Ն70 years and compared their outcomes with those of younger individuals. [21][22][23] We used this cutoff to facilitate comparison with these studies.…”

Section: Discussionmentioning

confidence: 99%

“…The RTOG experience has been reported by Langer et al 21,22 In the earlier report, RTOG investigators re-evaluated three separate trials that included various treatment combinations of chemotherapy and RT. 21 They reported that the median survival time in patients Ն 70 years was as follows: 11.4 months with qd RT alone, 9.3 months with bid RT alone, 11.0 months with induction chemotherapy followed by qd RT, 14.2 months with induction chemotherapy followed by concurrent chemotherapy plus qd RT, and 11.1 month with concurrent chemotherapy plus bid RT.…”

Section: Discussionmentioning

confidence: 99%

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The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

Schild

Stella

Geyer

et al. 2003

JCO

222

107

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Purpose: The North Central Cancer Treatment Group performed a phase III trial to determine whether chemotherapy plus either bid radiation therapy (RT) or daily (qd) RT resulted in a better outcome for patients with stage III nonsmall-cell lung cancer (NSCLC). No difference in survival was identified between the two arms. This secondary analysis was performed to examine the relationship between patient age and outcome.Patients and Methods: Two hundred forty-six patients were randomized to receive etoposide plus cisplatin and either RT qd or split-course RT bid. This retrospective study compared the outcomes of patients aged >70 years ("elderly patients") with those of younger individuals. Of the 244 assessable patients, 63 (26%) were elderly, and 181 (74%) were younger individuals.Results: The 2-year and 5-year survival rates were 39% and 18%, respectively, in patients younger than 70 years, compared with 36% and 13%, respectively, in elderly patients (P ‫؍‬ .4). Grade 4؉ toxicity occurred in 62% of patients younger than 70 years compared with 81% of elderly patients (P ‫؍‬ .007). Grade 4؉ hematologic toxicity occurred in 56% of patients younger than 70 years, compared with 78% of elderly patients (P ‫؍‬ .003). Grade 4؉ pneumonitis occurred in 1% of those younger than 70 years, compared with 6% of elderly patients (P ‫؍‬ .02).Conclusion: Toxicity, especially myelosuppression and pneumonitis, was more pronounced in the elderly patients receiving combined-modality therapy for locally advanced NSCLC. Despite increased toxicity, elderly patients have survival rates equivalent to younger individuals. Therefore, fit, elderly patients with locally advanced NSCLC should be encouraged to receive combined-modality therapy, preferably on clinical trials with cautious, judicious monitoring. Future studies should explore ways to decrease toxicity of therapy in elderly patients.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

Schild

Stella

Geyer

et al. 2003

JCO

222

107

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“…Some analyses have revealed similar outcomes and toxicity in elderly patients, whereas others have revealed age as a poor prognostic factor or a factor associated with a higher rate of toxicity. [9][10][11][12][13][14] In previous analyses, approximately 20% to 25% of patients enrolled in the trials analyzed were age $ 70 years, and the elderly subsets in these analyses were small (24 to 130 patients), which limits the interpretation. The US National Cancer Institute (NCI) -supported cooperative groups (now known as the National Clinical Trials Network) have performed phase II or III clinical trials investigating concurrent chemoradiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non–Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies

Stinchcombe

Zhang

Vokes

et al. 2017

JCO

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Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and MethodsIndividual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age $ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. ResultsA total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade $ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P , .01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P , .01), and more discontinued treatment because of AEs (20% v 13%; P , .01), died during treatment (7.8% v 2.9%; P , .01), and refused further treatment (5.8% v 3.9%; P = .02). ConclusionElderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.J Clin Oncol 35.

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“…The results of age-based retrospective subgroup analyses of randomized phase III trials that evaluated concurrent chemoradiotherapy were previously reported by 5 studies (18)(19)(20)(21)(22). Those studies reported that healthy older adults with locally advanced NSCLC benefitted from concurrent chemoradiotherapy similar to younger patients, but experienced higher rates of hospitalization and toxicity.…”

Section: Discussionmentioning

confidence: 70%

Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non-small-cell lung cancer: A case series of 20 patients

Takeshita

Masago

Fujita

et al. 2014

Molecular and Clinical Oncology

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Abstract. Elderly patients with stage III non-small-cell lung cancer (NSCLC) are frequently underrepresented in clinical trials that evaluate chemoradiotherapy, due to their poor functional status, coexisting illnesses and limited life expectancy. The Japan Clinical Oncology Group 0301 trial (JCOG0301) was the first study to demonstrate that thoracic radiation therapy (TRT) with daily low-dose carboplatin may improve the outcome of elderly patients with stage III NSCLC. However, the efficacy and safety profiles of chemoradiotherapy, including platinum doublets, have not been clearly determined in this patient population. We retrospectively assessed the efficacy and toxicity of weekly paclitaxel in combination with carboplatin and concurrent TRT in patients aged ≥75 years with previously untreated locally advanced NSCLC. Between February, 2004 and July, 2013, we collected the data of 20 patients treated with weekly paclitaxel and carboplatin for 6 weeks and concurrent TRT. The objective response rate was 90%, the disease control rate was 95%, the median progression-free survival was 8.63 months [95% confidence interval (CI): 5.7-16.7] and the median overall survival (OS) was 16.1 months (95% CI: 10.7-41.6). There were no grade 4 hematological or non-hematological toxicities and no reported treatment-related deaths. Therefore, platinum doublet therapy in combination with TRT did not provide a clinically significant survival benefit in our population of elderly patients with locally advanced NSCLC. However, the present study demonstrated the good feasibility and safety of this regimen. Further prospective clinical trials are required to evaluate the efficacy and safety of platinum doublet with TRT in elderly patients.

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Do elderly patients (pts) with locally advanced non-small cell lung cancer (NSCLC) benefit from combined modality therapy? a secondary analysis of RTOG 94-10

Cited by 86 publications

References 0 publications

The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non–Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies

Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non-small-cell lung cancer: A case series of 20 patients

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