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[Consensus of Chinese Experts on Medical Treatment of Advanced Lung Cancer
in the Elderly (2022 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:363-384. [PMID: 35747916 PMCID: PMC9244502 DOI: 10.3779/j.issn.1009-3419.2022.101.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shiono A, Imai H, Wasamoto S, Tsuda T, Nagai Y, Minemura H, Yamada Y, Kishikawa T, Umeda Y, Takechi H, Yamaguchi O, Mouri A, Kaira K, Taniguchi H, Minato K, Kagamu H. Real-world data of atezolizumab plus carboplatin and etoposide in elderly patients with extensive-disease small-cell lung cancer. Cancer Med 2022; 12:73-83. [PMID: 35699088 PMCID: PMC9844637 DOI: 10.1002/cam4.4938] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The aim of this study was to assess the effectiveness and tolerability of atezolizumab plus carboplatin and etoposide combination chemotherapy in elderly patients with extensive-disease (ED) small-cell lung cancer (SCLC). METHODS This retrospective study evaluated 65 SCLC patients who received atezolizumab, carboplatin, and etoposide for ED-SCLC in nine study institutions between August 2019 and September 2020. Clinical efficacy, assessed according to response rate and survival, and toxicity were compared between the elderly (n = 36 patients; median age: 74 years [range: 70-89 years]) and the non-elderly group (n = 29 patients; median age: 67 years [range: 43-69 years]). RESULTS The response rate was 73.8% (80.5% in the elderly group and 65.5% in the non-elderly group). There was no significant difference in both the median progression-free survival (5.5 months vs. 4.9 months, p = 0.18) and the median overall survival (15.4 months vs. 15.9 months, p = 0.24) between the elderly group and the non-elderly group. The frequencies of grade ≥3 hematological adverse events in the elderly patients were as follows: decreased white blood cells, 36.1%; decreased neutrophil count, 61.1%; decreased platelet count, 8.3%; and febrile neutropenia, 8.3%. One treatment-related death due to lung infection occurred in the elderly group. CONCLUSION Despite hematologic toxicities, especially decreased neutrophil count, atezolizumab, carboplatin, and etoposide combination chemotherapy demonstrates favorable effectiveness and acceptable toxicity in elderly patients. Thus, atezolizumab plus carboplatin and etoposide could be the preferred standard treatment modality for elderly patients with ED-SCLC.
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Affiliation(s)
- Ayako Shiono
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan
| | - Hisao Imai
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan,Division of Respiratory MedicineGunma Prefectural Cancer CenterOtaJapan
| | - Satoshi Wasamoto
- Division of Respiratory MedicineSaku Central Hospital Advanced Care CenterSakuJapan
| | - Takeshi Tsuda
- Division of Respiratory MedicineToyama Prefectural Central HospitalToyamaJapan
| | - Yoshiaki Nagai
- Department of Respiratory MedicineJichi Medical University, Saitama Medical CenterSaitamaJapan
| | - Hiroyuki Minemura
- Department of Pulmonary MedicineFukushima Medical UniversityFukushimaJapan
| | - Yutaka Yamada
- Division of Respiratory MedicineIbaraki Prefectural Central HospitalKasamaJapan
| | | | - Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical SciencesUniversity of FukuiEiheijiJapan
| | - Hiroki Takechi
- Division of Respiratory MedicineSaku Central Hospital Advanced Care CenterSakuJapan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan
| | - Atsuto Mouri
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan
| | - Hirokazu Taniguchi
- Division of Respiratory MedicineToyama Prefectural Central HospitalToyamaJapan
| | - Koichi Minato
- Division of Respiratory MedicineGunma Prefectural Cancer CenterOtaJapan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical CenterSaitama Medical UniversityHidakaJapan
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Hatami E, Nagesh PKB, Jaggi M, Chauhan SC, Yallapu MM. Gambogic acid potentiates gemcitabine induced anticancer activity in non-small cell lung cancer. Eur J Pharmacol 2020; 888:173486. [PMID: 32805254 DOI: 10.1016/j.ejphar.2020.173486] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the most frequent type of lung cancer accounting up to 80-85% of all lung cancer (LC) cases. Gemcitabine (Gem), a pyrimidine nucleoside antimetabolite, is widely used chemotherapy offering several months survival benefit in patients with NSCLC. The emergence of Gem resistance is a main clinical concern in cancer treatment and thus a continuous demand for development of new therapeutic strategies to improve its antitumor activity. Hence, we report an adjuvant therapeutic regimen based on natural compound, gambogic acid (GA) which has been shown to enhanced Gem induced inhibition of cancer cell growth, arrest cell cycle, and induce apoptosis by enhanced accumulation of Gem. The in vitro cell viability, clonogenicity, invasion, and migration assays demonstrated a significant higher therapeutic effect of Gem when it was combined with GA in A549 and H1299 cells. A better access of internalization of drug molecules achieved in rhodamine 123 assay when GA was used as adjuvant treatment. Further, GA and Gem combination significantly reduced tubular formation of HUVEC cells indicates lowering angiogenesis potential. Microarray and Western blot studies confirm that GA + Gem co-treatment strategy promotes cancer cell death by downregulating anti-apoptotic proteins, chemoresistance-associated proteins, and upregulation of apoptosis proteins. More importantly, a significant higher therapeutic benefit was noticed for GA and Gem combination in A549 xenograft mice model. Together, these results offer a rationale to evaluate the clinical translational possibility of GA as adjuvant therapy to overcome Gem resistance. This combination regimen can be a new therapeutic concept to eradicate this devastating disease.
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Affiliation(s)
- Elham Hatami
- Department of Pharmaceutical Sciences and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Prashanth K B Nagesh
- Department of Pharmaceutical Sciences and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA; Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meena Jaggi
- Department of Pharmaceutical Sciences and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA; The South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA
| | - Subhash C Chauhan
- Department of Pharmaceutical Sciences and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA; The South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA
| | - Murali M Yallapu
- Department of Pharmaceutical Sciences and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA; The South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, USA.
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Chen J, Liu B, Zhang F, Cui W, Zhang P. Pharmacokinetics and safety of lobaplatin plus etoposide in Chinese men older than 65 years with extensive-stage small cell lung cancer: a phase II clinical trial. Cancer Chemother Pharmacol 2019; 84:73-81. [DOI: 10.1007/s00280-019-03828-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
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Imai H, Yamada Y, Minemura H, Sugiyama T, Kotake M, Kaira K, Kanazawa K, Nakamura Y, Kasai T, Shibata Y, Kaburagi T, Minato K. Topotecan monotherapy for the treatment of relapsed small cell lung cancer in elderly patients: A retrospective analysis. Thorac Cancer 2018; 9:1699-1706. [PMID: 30281216 PMCID: PMC6275829 DOI: 10.1111/1759-7714.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Topotecan is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). However, its efficacy in elderly patients with SCLC has not been validated. This study evaluated the feasibility and efficacy of topotecan monotherapy in elderly patients with relapsed SCLC. Methods Between January 2000 and March 2017, 43 patients aged ≥ 70 years received topotecan monotherapy for relapsed SCLC at four institutions. The clinical outcomes and adverse events of treatment were retrospectively analyzed. Results Twenty‐nine patients (median age 75 years; range: 70–83 years) had sensitive‐type relapse, while 14 (median age 78 years; range: 71–82 years) had refractory relapse. The median number of treatment cycles was two (range: 1–6). The response rate was 7.0% (10.3% and 0% in sensitive and refractory patients, respectively), while the disease control rate was 23.2% (20.6% and 42.8% in sensitive and refractory patients, respectively). Median progression‐free survival was 1.9 months in sensitive patients and 1.4 months in refractory patients (P = 0.87). The median survival time from the start of topotecan therapy was 5.5 months in sensitive patients and 4.0 months in refractory patients (P = 0.64). Grade ≥ 3 hematological toxicities were as follows: leukopenia, 37.2%; neutropenia, 51.1%; anemia, 0%; thrombocytopenia, 32.5%; and febrile neutropenia, 9.3%. No treatment‐related deaths occurred. Conclusion Although hematological toxicities (particularly neutropenia) were severe, topotecan showed favorable disease control in both sensitive and refractory patients. Topotecan may thus be a preferred treatment for elderly patients with relapsed SCLC.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Yutaka Yamada
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Mie Kotake
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoichi Nakamura
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Takashi Kasai
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
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Imai H, Sugiyama T, Tamura T, Minemura H, Kaira K, Kanazawa K, Yokouchi H, Kasai T, Kaburagi T, Minato K. A retrospective study of amrubicin monotherapy for the treatment of relapsed small cell lung cancer in elderly patients. Cancer Chemother Pharmacol 2017; 80:615-622. [PMID: 28761968 PMCID: PMC5573757 DOI: 10.1007/s00280-017-3403-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Abstract
Purpose Amrubicin is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). Previous studies reported its effectiveness and severe hematological toxicity. However, the efficacy of amrubicin monotherapy in elderly patients with SCLC has not been described. The objective of this study was to investigate the feasibility of amrubicin monotherapy in elderly patients and its efficacy for relapsed SCLC. Methods A retrospective cohort study design was used. We retrospectively evaluated the clinical effects and adverse events of amrubicin treatment in elderly (≥70 years) SCLC patients with relapsed SCLC. Results Between November 2003 and September 2015, 86 patients (aged ≥70 years) received amrubicin monotherapy for relapsed SCLC at four institutions. There were 42 cases of sensitive relapse (S) and 44 of refractory relapse (R). S cases with median age of 75 years (range 70–85 years) and R cases with median age of 74 years (range 70–84 years) were included in our analysis. The median number of treatment cycles was three (range 1–9), and the response rate was 33.7% (40.5% in the S and 27.2% in the R cases). Median progression-free survival time was 4.0 months in the S and 2.7 months in the R patients (p = 0.013). Median survival time from the start of amrubicin therapy was 7.6 months in the S and 5.5 months in the R cases (p = 0.26). The frequencies of grade ≥3 hematological toxicities were as follows: leukopenia, 60.4%; neutropenia, 74.4%; anemia, 11.6%; thrombocytopenia, 16.2%; and febrile neutropenia, 17.4%. Treatment-related death was observed in one patient. Conclusion Although hematological toxicities, particularly neutropenia, were severe, amrubicin showed favorable efficacy, not only in the S but also in the R cases, as shown in previous studies. Amrubicin could be a preferable standard treatment in elderly patients with relapsed SCLC. These results warrant further evaluation of amrubicin in elderly patients with relapsed SCLC by a prospective trial. Electronic supplementary material The online version of this article (doi:10.1007/s00280-017-3403-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ohta, Gunma, 373-8550, Japan.
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Tomohiro Tamura
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiroshi Yokouchi
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kasai
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ohta, Gunma, 373-8550, Japan
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Okamoto K, Okamoto I, Takeda M, Kobayashi S, Takeda K, Nakamatsu K, Nishimura Y, Nakagawa K. A Phase I Study of Split-dose Cisplatin and Etoposide with Concurrent Accelerated Hyperfractionated Thoracic Radiotherapy in Elderly Patients with Limited-disease Small Cell Lung Cancer. Jpn J Clin Oncol 2014; 44:743-748. [DOI: 10.1093/jjco/hyu071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Shukuya T, Takahashi T, Harada H, Ono A, Akamatsu H, Taira T, Kenmotsu H, Naito T, Murakami H, Endo M, Takahashi K, Yamamoto N. Chemoradiotherapy for Limited-disease Small-cell Lung Cancer in Elderly Patients Aged 75 Years or Older. Jpn J Clin Oncol 2013; 43:176-183. [DOI: 10.1093/jjco/hys197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Central pontine myelinolysis presented after prophylactic cranial irradiation in small cell lung cancer. Neurol Sci 2011; 32:1161-3. [DOI: 10.1007/s10072-011-0601-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 04/22/2011] [Indexed: 11/28/2022]
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10
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Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity. Arch Gynecol Obstet 2010; 284:1007-14. [PMID: 21116639 PMCID: PMC3171672 DOI: 10.1007/s00404-010-1777-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/11/2010] [Indexed: 11/22/2022]
Abstract
Purpose To examine the preliminary survival outcomes and treatment-related toxicity for elderly patients with cervical cancer treated with radiotherapy (RT). Methods Forty patients ≥75 years old with cervical cancer who were treated with RT were evaluated. Of these 40 patients, 25 were classified as FIGO stage I or II and 15 as stage III or IVA. Thirty-five patients were treated with radical RT (RRT), and five were treated with surgery plus adjuvant RT (S + ART). External beam radiotherapy combined with high-dose-rate intracavitary brachytherapy was performed on 31 patients who were treated with RRT and on 2 patients who were treated with S + ART because of positive vaginal surgical margins. The patients’ median age was 78 years (range 75–89 years). Concurrent chemotherapy (CCT) was performed on five patients (RRT: 3, S + ART: 2). Results The median follow-up period was 20 months (range 1–85 months). Only one patient could not complete RT. The 3-year overall and disease-specific survival (OS and DSS) rates for all patients were 58 and 80%, respectively. Five patients experienced Grade 3 acute toxicity; two were treated with RRT (2/35), and three were treated with S + ART (3/5, 2 of them with CCT). Two patients experienced Grade 3 late toxicity; one was treated with RRT (1/35, with CCT) and the other was treated with S + ART (1/5). No Grade 4 or higher toxicity was experienced. Conclusions RRT for elderly patients with cervical cancer is generally effective and safe, but severe toxicity may occur with more aggressive treatment modalities.
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Inoue A, Ishimoto O, Fukumoto S, Usui K, Suzuki T, Yokouchi H, Maemondo M, Kanbe M, Ogura S, Harada T, Oizumi S, Harada M, Sugawara S, Fukuhara T, Nukiwa T. A phase II study of amrubicin combined with carboplatin for elderly patients with small-cell lung cancer: North Japan Lung Cancer Study Group Trial 0405. Ann Oncol 2010; 21:800-803. [DOI: 10.1093/annonc/mdp384] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nakao M, Oguri T, Suzuki T, Kunii E, Tomita Y, Iwashima Y, Miyazaki M, Maeno K, Sato S, Ueda R. Amrubicin monotherapy for elderly patients with previously treated lung cancer. Intern Med 2010; 49:1857-62. [PMID: 20823645 DOI: 10.2169/internalmedicine.49.3606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The novel anthracycline agent amrubicin, has been approved in Japan to treat small and non-small cell lung cancers (SCLC and NSCLC). The present study evaluates the toxicity and effect of amrubicin especially in elderly patients with previously treated lung cancer. PATIENTS AND METHODS This retrospective study analyzed data from 51 patients (<70 years of age, n=29; > oor =70 years of age, n=22) with lung cancer (NSCLC, n=21; SCLC, n=30) who were treated with amrubicin at our hospital, between July 2003 and October 2009. All patients had recurrent or refractory lung cancer after one or more chemotherapy regimens. We compared the outcomes of patients younger and older than 70 years of age. Amrubicin (30-40 mg/m(2)/day) was infused depending on patient performance status and laboratory data over a period of 5 minutes on days 1-3, with courses repeated at intervals of at least 3 weeks. The dose was modified according to myelosuppression. RESULTS The mean number of treatment cycles, mean dose and mean interval of amrubicin administration did not significantly differ between patients aged <70 and > or =70 years. The rate of hematological toxicities (> or = Grade 3) also did not significantly differ between the two age groups (leukopenia, 48.3% and 59.1% for age <70 and > or =70 years, p=0.573; neutropenia, 65.5% vs. 77.3%, p=0.536; anemia, 20.7% vs. 22.7%, p=1.000; thrombocytopenia, 13.8% vs. 31.8%, p=0.173). The incidence of grade 2-4 non-hematological toxicities also did not significantly differ between the groups. The response rate of SCLC and disease control rate of NSCLC were similar in the younger and older groups. CONCLUSION Amrubicin monotherapy might be equally tolerated by elderly and younger patients. Further studies are needed to investigate the benefit of amrubicin monotherapy among elderly patients with previously treated lung cancer.
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Affiliation(s)
- Makoto Nakao
- Department of Medical Oncology and Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan
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Li J, Chen P, Dai CH, Li XQ, Bao QL. Outcome and treatment in elderly patients with small cell lung cancer: a retrospective study. Geriatr Gerontol Int 2009; 9:172-82. [PMID: 19740361 DOI: 10.1111/j.1447-0594.2009.00525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The number of elderly patients with small cell lung cancer (SCLC) is expected to increase with the growing geriatric population. The aim of this study is to evaluate the safety and efficacy of standard chemotherapy or chemoradiotherapy in elderly patients with SCLC. METHODS In this retrospective study, we analyzed the data of 126 patients with SCLC diagnosed between 1996 and 2005 at our hospital, and compared the outcome of younger patients less than 70 years and elderly patients 70 years or older who were treated with etoposide and cisplatin (EP regimen) and cyclophosphamide, adriamycin and vincristine (CAV regimen). Patients with limited disease SCLC received thoracic radiotherapy (RT) following chemotherapy. RESULTS Overall response rates (complete and partial response) were not significantly different between patients less than 70 years and patients 70 years or older (69% vs 65%, P = 0.591). The median survival time was 13 months for patients less than 70 years compared with 12 months for patients 70 years or older (P = 0.263), with 2- and 5-year survival rates of 37.8% and 8.2% vs 26.2% and 3.6%, respectively. Progression-free survival of patients 70 years or older was similar to that of patients less than 70 years (P = 0.445). Grade 3 and 4 hematological toxicities were more frequent among the elderly group (leukopenia, 48% vs 31%, P = 0.049; neutropenia, 52% vs 32%, P = 0.028; thrombocytopenia, 38% vs 21%, P = 0.047). CONCLUSION In spite of having more grade 3 and 4 hematological toxicity, elderly SCLC patients 70 years or older can benefit from the EP regimen and the CAV regimen with or without thoracic RT. Further investigations are needed to focus on ways to decrease toxicity, especially in the elderly.
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Affiliation(s)
- Jian Li
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Jiangsu, China.
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Okamoto K, Okamoto I, Takezawa K, Tachibana I, Fukuoka M, Nishimura Y, Nakagawa K. Cisplatin and Etoposide Chemotherapy Combined with Early Concurrent Twice-daily Thoracic Radiotherapy for Limited-disease Small Cell Lung Cancer in Elderly Patients. Jpn J Clin Oncol 2009; 40:54-9. [DOI: 10.1093/jjco/hyp137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
With about 20% of all lung cancers small cell lung cancer (SCLC) represents a major subset of this entity. Although therapeutic improvements did not receive as much attention as in non small cell lung cancer (NSCLC), many small steps of clinical progress have been achieved within the last 20 years. An optimal treatment should be based on an interdisciplinary treatment plan. The standard treatment in localized stages represents combined radiation and chemotherapy. Cisplatin and etoposide are in this concern considered as a gold standard. 3D-planned conformal radiotherapy should start as early as possible and should be applied concomitantly to chemotherapy and in certain cases even in a hyperfractionated treatment protocol. In very early stages surgical resection could be an option in selected cases. In advanced stages a platinum-based doublet offers high response rates. As already established in limited disease prophylactic cranial irradiation is now also indicated in extensive disease in case of any tumor remission. In the second line treatment and in patients with reduced performance status topotecan is recommended. Similar as in NSCLC pemetrexed might become an alternative treatment option in the second line setting. In the field of new targeted therapies bevacizumab achieved the most promising results. The present review highlights historical milestones and up-to-date trends in radiotherapy, chemotherapy and surgery. Furthermore, the role of experimental strategies and the management of certain special clinical situations are discussed.
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Shimizu T, Sekine I, Sumi M, Ito Y, Yamada K, Nokihara H, Yamamoto N, Kunitoh H, Ohe Y, Tamura T. Concurrent Chemoradiotherapy for Limited-disease Small Cell Lung Cancer in Elderly Patients Aged 75 Years or Older. Jpn J Clin Oncol 2007; 37:181-5. [PMID: 17426103 DOI: 10.1093/jjco/hym005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal treatment for limited-disease small cell lung cancer (LD-SCLC) in patients aged 75 years or older remains unknown. METHODS Elderly patients with LD-SCLC who were treated with chemoradiotherapy were retrospectively reviewed to evaluate their demographic characteristics and the treatment delivery, drug toxicities and antitumor efficacy. RESULTS Of the 94 LD-SCLC patients treated with chemotherapy and thoracic radiotherapy at the National Cancer Center Hospital between 1998 and 2003, seven (7.4%) were 75 years of age or older. All of the seven patients were in good general condition, with a performance status of 0 or 1. Five and two patients were treated with early and late concurrent chemoradiotherapy, respectively. While the four cycles of chemotherapy could be completed in only four patients, the full dose of radiotherapy was completed in all of the patients. Grade 4 neutropenia and thrombocytopenia were noted in seven and three patients, respectively. Granulocyte-colony stimulating factor support was used in five patients, red blood cell transfusion was administered in two patients and platelet transfusion was administered in one patient. Grade 3 or more severe esophagitis, pneumonitis and neutropenic fever developed in one, two and three patients, respectively, and one patient died of radiation pneumonitis. Complete response was achieved in six patients and partial response in one patient. The median survival time was 24.7 months, with three disease-free survivors for more than 5 years. CONCLUSION Concurrent chemoradiotherapy promises to provide long-term benefit with acceptable toxicity for selected patients of LD-SCLC aged 75 years or older.
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Affiliation(s)
- Toshio Shimizu
- Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Townsley CA, Pond GR, Oza AM, Hirte HW, Winquist E, Goss G, Degendorfer P, Moore MJ, Siu LL. Evaluation of adverse events experienced by older patients participating in studies of molecularly targeted agents alone or in combination. Clin Cancer Res 2006; 12:2141-9. [PMID: 16609027 DOI: 10.1158/1078-0432.ccr-05-1798] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The tolerability of molecularly targeted agents in older patients has not been specifically examined. Adverse event data from clinical trials in the Princess Margaret Hospital Phase II Consortium database were analyzed to address this question. METHODS The Consortium database collects trial information on all patients treated with either a molecularly targeted agent alone or in combination since 2001. The frequency of adverse events was determined and analyzed by two different age groups, <65 years and >/=65 years. Toxicity indices (TI) and frequencies of dose-limiting toxicities (DLT), based on adverse events of all causalities (TI(ALL) and DLT(ALL)), and on adverse events that were at least possibly related to the molecularly targeted agent (TI(MTA) and DLT(MTA)), were calculated for both age groups. RESULTS Four hundred and one patients who received 1,252 treatment cycles were analyzed from 19 different studies. Baseline performance status was similar between both age groups, but fewer older patients have had multiple prior regimens of chemotherapy or prior radiation therapy. A comparison of the proportions of younger and older patients experiencing DLT(ALL) and DLT(MTA) showed similar results. The TI(MTA) values were comparable between the two age groups in both single agent (3.25 versus 3.00, for <65 versus >/=65 years) and multi-agent (3.65 versus 3.00, for <65 versus >/=65 years) trials. CONCLUSIONS Older patients seem to tolerate molecularly targeted therapies either alone or in combination with chemotherapy as well as younger patients. Age alone should not be a barrier in the administration of targeted agents.
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A Phase I Study of Amrubicin Combined with Carboplatin for Elderly Patients with Small-Cell Lung Cancer. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30358-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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A Phase I Study of Amrubicin Combined with Carboplatin for Elderly Patients with Small-Cell Lung Cancer. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200607000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bernardi D, Errante D, Tirelli U, Salvagno L, Bianco A, Fentiman IS. Insight into the treatment of cancer in older patients: Developments in the last decade. Cancer Treat Rev 2006; 32:277-88. [PMID: 16698183 DOI: 10.1016/j.ctrv.2006.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 03/17/2006] [Accepted: 03/20/2006] [Indexed: 11/15/2022]
Abstract
In the last decades there has been an increased interest in the treatment of elderly cancer patients and a change in attitude of both clinicians and their patients has occurred. Drugs are now available that might be considered "elderly-friendly" and the enormous advances in surgical procedures and supportive treatments over the recent years have enabled adverse effects to be minimized. A Geriatric Assessment is increasingly used as a tool to define those patients who are more suitable for aggressive chemotherapy or, on the contrary, palliative treatment. For almost all cancers, older patients are better treated today than they were in the past, even though we are still far from optimal management. Despite the perceived barriers to including elderly patients in clinical trials, there are few data to support excluding them. We must not permit increased age in cancer patients to continue to be an important and independent risk factor for receiving inadequate care.
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Affiliation(s)
- Daniele Bernardi
- Division of Medical Oncology, Ospedale Civile, Via Forlanini 71, 31029 Vittorio Veneto (TV), Italy.
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Sekine I, Takada M, Nokihara H, Yamamoto S, Tamura T. Knowledge of Efficacy of Treatments in Lung Cancer Is Not Enough, Their Clinical Effectiveness Should Also Be Known. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31600-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Knowledge of Efficacy of Treatments in Lung Cancer Is Not Enough, Their Clinical Effectiveness Should Also Be Known. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200606000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Garst J, Buller R, Lane S, Crawford J. Topotecan in the treatment of elderly patients with relapsed small-cell lung cancer. Clin Lung Cancer 2006; 7:190-6. [PMID: 16354314 DOI: 10.3816/clc.2005.n.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Almost 70% of all patients with lung cancer in the United States are>65 years of age, and the incidence of small-cell lung cancer (SCLC) increases with age until the eighth decade of life. However, elderly patients are underrepresented in clinical trials and are often suboptimally treated. The validity of age as a prognostic factor for toxicity or survival remains controversial. PATIENTS AND METHODS To investigate the safety and efficacy of topotecan (an approved treatment for relapsed SCLC) in older patients, we performed a retrospective analysis in patients >or= 65 years of age versus patients < 65 years of age from 5 large topotecan trials. In all 5 trials, patients received topotecan 1.5 mg/m2 per day via a 30-minute intravenous infusion on days 1 through 5 of a 21-day cycle. Efficacy and tolerability outcomes were assessed for both age groups. RESULTS Topotecan was similarly tolerated in both age groups, with generally manageable hematologic toxicity. The incidence, duration, and onset of severe hematologic toxicities did not vary significantly with age. In the<65 age group, grade 4 neutropenia and leukopenia were reported in 72% and 32% of patients, respectively; in the >or= 65 age group, grade 4 neutropenia and leukopenia were reported in 77% and 31% of patients, respectively. Grade 4 thrombocytopenia was less common in the<65 age group. Nonhematologic toxicities, median time to progression, and overall survival were comparable between groups. CONCLUSION This is the first demonstration of the safety and efficacy of topotecan in older patients with recurrent SCLC. Future studies are needed to fully characterize the role of topotecan in the treatment of older patients.
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Affiliation(s)
- Jennifer Garst
- Department of Medicine, Oncology, Duke Comprehensive Cancer Center, Durham, NC 27710, USA.
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Townsley C, Pond GR, Peloza B, Kok J, Naidoo K, Dale D, Herbert C, Holowaty E, Straus S, Siu LL. Analysis of treatment practices for elderly cancer patients in Ontario, Canada. J Clin Oncol 2005; 23:3802-10. [PMID: 15923574 DOI: 10.1200/jco.2005.06.742] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Older patients are underrepresented in many areas of cancer services utilization and in clinical trial enrollment. This study evaluates whether age, when adjusted for sex, comorbidity, stage, tumor site, geography, and time period, is predictive of cancer treatment practice. METHODS First, we used the Ontario Cancer Registry (OCR) to examine for any apparent differences in treatment practices between elderly (> or = 70 years) and younger patients in the last three decades. Second, we performed a chart review of 1,505 patients with lung, breast, and colorectal cancers seen in Ontario either at an urban center, the Princess Margaret Hospital, or at a rural center, the Northwestern Regional Cancer Centre. Patients were randomly selected from two time periods, 1977 to 1978 and 1997; and the study population was to comprise at least 50% elderly patients. RESULTS OCR data demonstrated that, in some settings, such as colorectal cancer, the proportions of elderly cancer patients who were referred to cancer centers and who received any cancer treatment were lower than their younger counterparts. The chart review data showed that increasing age was a significant negative predictor for receiving any cancer treatment (P < .001, multivariate analysis) and for having a clinical trial discussion with the treating specialist (P < .001, multivariate analysis). CONCLUSION Independent of other factors, older age is consistently a cause of disparity in cancer treatment practice and in clinical trial discussion with patients. By increasing the accrual rate of elderly cancer patients in clinical trials, a better understanding of appropriate therapies for this patient population can be obtained and may, thereby, impact on their cancer-related morbidity and mortality.
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Affiliation(s)
- Carol Townsley
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, 610 University Ave, Ste 5-210, Toronto, Ontario, M5G 2M9, Canada
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