|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 380-381
Is age just a number for patients with epidermal growth factor receptor-positive lung cancer?
Amish D Vora1, Nikita Nikita2
1 HOPE Oncology Center, Delhi, India
2 Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA, India
|Date of Submission||11-Mar-2020|
|Date of Decision||14-Mar-2020|
|Date of Acceptance||16-Apr-2020|
|Date of Web Publication||19-Jun-2020|
Amish D Vora
HOPE Oncology Center, Delhi
Source of Support: None, Conflict of Interest: None
|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 Jul 7];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., 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., 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., 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. Third, although EGFR mutations are more likely to occur among non-smokers, 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.
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.
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Conflicts of interest
There are no conflicts of interest.
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