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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 380-381

Is age just a number for patients with epidermal growth factor receptor-positive lung cancer?


1 HOPE Oncology Center, Delhi, India
2 Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA, India

Date of Submission11-Mar-2020
Date of Decision14-Mar-2020
Date of Acceptance16-Apr-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Amish D Vora
HOPE Oncology Center, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_81_20

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How to cite this article:
Vora AD, Nikita N. Is age just a number for patients with epidermal growth factor receptor-positive lung cancer?. Cancer Res Stat Treat 2020;3:380-1

How to cite this URL:
Vora AD, Nikita N. Is age just a number for patients with epidermal growth factor receptor-positive lung cancer?. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 19];3:380-1. Available from: http://www.crstonline.com/text.asp?2020/3/2/380/287272



The recent original article in the geriatric oncology section of the journal, titled, “The efficacy and safety of first-line therapy for the epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer in older versus younger patients: A pooled analysis of two randomized controlled trials” and the accompanying editorial provide great insights into a global controversy.[1],[2] Is age just a number for patients with lung cancer? The original article is a pooled analysis of two Phase III randomized clinical trials: in the first study, patients received oral gefitinib daily or a pemetrexed/carboplatin doublet followed by maintenance pemetrexed; in the second trial, patients received either oral gefitinib with pemetrexed/carboplatin or gefitinib alone.[3],[4] The pooled analysis compares the overall survival (OS), progression-free survival (PFS), and Grade III/IV toxicities between younger and older patients. We want to congratulate the authors for answering this important question, which is relevant to everyday clinical practice.

In this study, patients aged 60 years or more were considered as older patients. They were further stratified as “young-old” for patients aged between 60 and 69 years and “old-old” for patients aged over 70 years.

This study has several strengths and tries to address some very pertinent questions about the care of older adults with lung cancer. First, it is the first study focused on the differences in the OS and PFS of older patients. Second, this study includes patients with the Eastern Cooperative Oncology Group (ECOG) performance status ranging from 0 to 2, whereas most clinical trials include patients with ECOG performance status ranging from 0 to 1. Third, the authors considered the role of comorbidities in the study and found no significant differences between younger and older patients.

Nevertheless, we have some suggestions and comments. First, the results are crude, as no multivariate analysis was performed. Given that, EGFR mutations are more common in women than men, adding a multivariate analysis to the results would further complement the authors' findings.[5],[6] Second, as the median age of the cohort is low, a comparison between the outcomes of younger (<50 years) and older patients (>60 years) would be interesting, as patients with non-small cell lung cancer <50 years of age usually fare poorly compared to others.[5] Third, although EGFR mutations are more likely to occur among non-smokers,[5] the authors found that the OS of older patients who smoked was lower than that of younger patients. Given that tobacco users are resistant to anti-EGFR therapy, the decrease in the OS could be attributed to the long-term tobacco use among older patients.[5]

All the same, the study brings to light some very important findings among older patients with lung cancer in India, and the results from the study cannot be undermined. However, even with these findings, oncologists must be wary of using similar drugs among older patients. Supplementing these findings with a randomized controlled trial would help validate the results and provide oncologists with more avenues for the treatment of lung cancer in older adults.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kapoor A, Noronha V, Patil VM, Joshi A, Menon N, Chougule A, et al. The efficacy and safety of first-line therapy for the epidermal growth factor receptor mutant non-small cell lung cancer in older versus younger patients: A pooled analysis of two randomized controlled trials. Cancer Res Stat Treat 2020;3:44-50.  Back to cited text no. 1
  [Full text]  
2.
Friedlaender A, Addeo A. Age is a fact and not an exclusion criterion in EGFR treatment. Cancer Res Stat Treat 2020;3:85-6.  Back to cited text no. 2
  [Full text]  
3.
Patil VM, Noronha V, Joshi A, Choughule AB, Bhattacharjee A, Kumar R, et al. Phase III study of gefitinib or pemetrexed with carboplatin in EGFR-mutated advanced lung adenocarcinoma. ESMO Open 2017;2:e000168.  Back to cited text no. 3
    
4.
Noronha V, Patil VM, Joshi A, Menon N, Chougule A, Mahajan A, et al. Gefitinib versus gefitinib plus pemetrexed and carboplatin chemotherapy in EGFR-mutated lung cancer. J Clin Oncol 2020;38:124-36.  Back to cited text no. 4
    
5.
Jackman DM, Yeap BY, Sequist LV, Lindeman N, Holmes AJ, Joshi VA, et al. Exon 19 deletion mutations of epidermal growth factor receptor are associated with prolonged survival in non–small cell lung cancer patients treated with gefitinib or erlotinib. Clin Cancer Res 2006;12:3908-14.  Back to cited text no. 5
    
6.
Rajendra A, Noronha V, Joshi A, Patil VM, Menon N, Prabhash K. Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management. Cancer Res Stat Treat 2019;2:36-53.  Back to cited text no. 6
  [Full text]  



This article has been cited by
1 Authorsę reply to Vora et al. and Singh et al.
Akhil Kapoor,Vanita Noronha,VijayM Patil,Amit Joshi,Nandini Menon,Anuradha Chougule,Pratik Chandrani,Vaishakhi Trivedi,Vichitra Behel,Rajiv Kumar,Abhishek Mahajan,Amit Janu,Kumar Prabhash
Cancer Research, Statistics, and Treatment. 2020; 3(2): 383
[Pubmed] | [DOI]



 

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