Treatment of Small Cell Lung Cancer in the Elderly

Rossi, Antonio; Maione, Paolo; Colantuoni, Giuseppe; Guerriero, Ciro; Ferrara, Carmine; Gaizo, Filomena Del; Nicolella, Dario; Gridelli, Cesare

doi:10.1634/theoncologist.10-6-399

Cited by 47 publications

(32 citation statements)

References 88 publications

(93 reference statements)

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“…Eight out of the nine trials included radiation. There was no statistically significant difference in 2-year, 3-year or 5-year survival in elderly patients versus younger patients in seven out of the nine trials [12]. Five retrospective studies of chemoradiation in the elderly mostly involving the CAV regimen or cisplatin and etoposide demonstrated overall response rates of 50-82%.…”

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confidence: 82%

“…Retrospective studies Rossi et al reviewed nine retrospective studies involving elderly patients with SCLC who received chemotherapy [12]. Elderly was defined as being 70 years or older in eight out of the nine studies.…”

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confidence: 99%

“…Prospective studies Eleven Phase II trials of chemotherapy involving mostly carboplatin and etoposide in elderly patients with both limited stage and extensive stage disease reported response rates of 57.8-93% and median survivals of 7.9-15.1 months [12]. A Phase II trial of carboplatin and irinotecan in patients aged 70-86 with limited or extensive stage SCLC demonstrated a response rate of 83.3% (95% CI: 65.3-94.4%), a median overall survival of 26 months for limited stage patients and a median overall survival of 11 months for extensive stage patients [13].…”

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confidence: 99%

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The benefit of chemotherapy in elderly patients with small cell lung cancer

Caprario¹,

Strauss

2014

Expert Review of Anticancer Therapy

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confidence: 82%

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confidence: 99%

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confidence: 99%

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The benefit of chemotherapy in elderly patients with small cell lung cancer

Caprario¹,

Strauss

2014

Expert Review of Anticancer Therapy

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“…19 Randomized controlled trial results strongly influence treatment guidelines, but trials typically enroll younger and healthier patients than the general patient population with the index cancer. 20 Older patients often have more comorbidities 21 and experience more toxicity with standard chemotherapy regimens, 22 but these patients and their physicians currently make treatment decisions on the basis of evidence from clinical trial populations. Our study addresses this gap by comparing the morbidity and mortality among elderly Medicare patients with ES SCLC after first-line treatment with cisplatin/etoposide versus carboplatin/etoposide in the ambulatory usual care setting.…”

Section: Introductionmentioning

confidence: 99%

Survival and Toxicity After Cisplatin Plus Etoposide Versus Carboplatin Plus Etoposide for Extensive-Stage Small-Cell Lung Cancer in Elderly Patients

Hatfield

Huskamp

Lamont

2016

JOP

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QUESTION ASKED: How do survival and health care utilization differ for older patients with advanced small-cell lung cancer after treatment with two distinct first-line chemotherapy regimens: cisplatin/etoposide versus carboplatin/etoposide? SUMMARY ANSWER: Survival after each regimen was nearly identical, but patients who received carboplatin/etoposide used less subsequent hospital-based health care than similar patients who received cisplatin/etoposide. WHAT WE DID:We identified patients with a first cancer diagnosis of extensive-stage small-cell lung cancer from the SEER cancer registries, which include detailed tumor information. Then using linked Medicare claims, we identified additional clinical details, cancer treatments, post-treatment health care utilization, and survival. We limited our study to patients who received first-line cisplatin/etoposide or carboplatin/etoposide in the outpatient setting. Each patient who received cisplatin/etoposide was matched to two patients who received carboplatin/etoposide using propensity scores that balanced demographic factors such as age, sex, and SEER region and clinical factors such as cancer characteristics, prior non-chemotherapy cancer treatments, prior health care utilization, and comorbidities. We compared post-treatment survival using non-inferiority tests and post-treatment health care utilization using conventional hypothesis tests.WHAT WE FOUND: Survival after cisplatin/etoposide was 35.7 weeks and after carboplatin/ etoposide was 35.9 weeks; statistical tests demonstrated that survival after carboplatin/etoposide was non-inferior to cisplatin/etoposide. After treatment, patients who received carboplatin/ etoposide were less likely to be admitted to the hospital (80% v 86%), but not the ICU or ED. They also had fewer hospitalizations, ICU stays, and ED visits, but lengths of stay (for those who were hospitalized) were not different between the two treatment groups. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS:Ideally, patients and physicians tailor treatments to individual clinical and personal characteristics. Treatment selection biases naïve comparisons between treatments when these characteristics also predict outcomes. For example, in our unmatched sample, patients who received cisplatin/ etoposide were younger and healthier. Although our matching method nearly eliminated the observable differences between the two treatment groups, unobservable differences may remain. For example, patients who received cisplatin/etoposide may have preferred more aggressive treatment or had oncologists who preferred more aggressive treatment. Our sample restrictions, designed to make our comparisons more valid, limit the population to which we can generalize our conclusions. Our results apply only to Traditional Medicare enrollees with 2 years of continuous enrollment in Parts A and B diagnosed with extensive-stage small-cell lung cancer as a first cancer who receive first-line chemotherapy in the ambulatory setting. Despite clinical practice guidelines that cont...

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“…The current primary therapy options for SCLC include chemotherapy (CT) and radiotherapy (RT). SCLC has a poor prognosis in the long run even though it is responsive to CT (2). Various studies have been carried out in an effort to gain insight into factors with an impact on prognosis for SCLC.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Survival in Small Cell Lung Cancer

et al. 2016

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Objective: Small cell lung cancer (SCLC) constitutes about 15-25 % of lung cancers with high mortality rate. Herein we observed the effect of parameters at the time of diagnosis to survival of cases with SCLC. Methods: We evaluated 65 patients who were followed up in our oncology department retrospectively. Results: Tumor location and stage at the time of diagnosis, smoking history, accompanying comorbidities, ECOG PS, laboratory parameters and treatments applied in pursuit were evaluated. 3-month survival rate of patients was 75.9%, 50.2% for 6-month, 21.4% for 1 year, and 5.5% for 2 years during follow up. ECOG PS and stage were found statistically significant risk factors in model created to determine overall survival. Conclusion: Performance score at the time of diagnosis, stage and presence of liver metastasis are identified as prognostic factors for SCLC and of these factors are quite valuable to predict the clinical outcome.

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Treatment of Small Cell Lung Cancer in the Elderly

Cited by 47 publications

References 88 publications

The benefit of chemotherapy in elderly patients with small cell lung cancer

The benefit of chemotherapy in elderly patients with small cell lung cancer

Survival and Toxicity After Cisplatin Plus Etoposide Versus Carboplatin Plus Etoposide for Extensive-Stage Small-Cell Lung Cancer in Elderly Patients

Factors Affecting Survival in Small Cell Lung Cancer

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