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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 381-382

Lung cancer in older patients: Age is not just a number!


1 Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Clinical Specialist, Respiratory Medicine, Army Hospital (R & R), New Delhi, India

Date of Submission12-Mar-2020
Date of Decision14-Mar-2020
Date of Acceptance15-Mar-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Pawan Kumar Singh
Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_83_20

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How to cite this article:
Singh PK, Chaudhry D, Saxena P. Lung cancer in older patients: Age is not just a number!. Cancer Res Stat Treat 2020;3:381-2

How to cite this URL:
Singh PK, Chaudhry D, Saxena P. Lung cancer in older patients: Age is not just a number!. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 23];3:381-2. Available from: http://www.crstonline.com/text.asp?2020/3/2/381/287274



Kapoor et al., through their pooled analysis, delivered an important message by concluding that older patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) have similar toxicities and survivals as their younger counterparts.[1],[2] The data were derived from two Indian randomized controlled trials, both conducted by the same group of authors.[3],[4] It has been shown that EGFR-tyrosine kinase inhibitors (TKIs) have a better efficacy and safety profile for the treatment of EGFR-mutated NSCLC.[5] Hence, they are unquestionably superior even in older patients. In fact, safety is preferred over efficacy in certain frail subjects, particularly the older ones.

The choice of 60 years as a definition of the geriatric age group is commendable. There is a difference of 10 years in the life expectancies of the Indian and American populations. Hence, adopting the Western definition of the geriatric age group would not have been appropriate. In Kapoor et al.'s study, the number of subjects was significantly lower in the “old-old” subgroup than the other subgroups. This reflects the nihilistic attitude of the caregivers and community toward the patients and their disease.[6] This study contributes to busting such myths and adds to the efforts toward changing such beliefs.

However, age is not the only factor that impacts the outcome of lung cancer management. EGFR-TKIs have been proven to be less efficacious in heavy smokers than in former-or non-smokers.[7] Older patients who are smokers, overall have more tobacco exposure than their younger counterparts because of the relatively late diagnosis and smoking cessation. This reflects in the poor median overall survival of older smokers as compared to that of young smokers.

In addition to age, comorbidities also impact the use of EGFR-TKIs. In this study, a sub-group analysis of comorbidities revealed unexpected findings. Most older patients had no comorbidities, whereas most of the younger patients suffered from at least one coexisting illness. This could have been due to a selection bias or failure to report comorbidities, as some of the illnesses could have been mistaken as mere symptoms of aging. It could also be due to the exclusion criteria or because some patients and caregivers refrain from treatment, considering its futility in the presence of comorbidities.

Drug–drug interactions and their impact on the pharmacokinetics of EGFR-TKIs is becoming increasingly apparent nowadays.[8] Most of the older Indian population takes one or another drug, like anti-platelets, proton-pump inhibitors, anti-hypertensives, or theophyllines. Therefore, in addition to the non-oncological evaluation of the older subjects, the authors could have analyzed the data for such drug–drug interactions. This would have added to the generalizability of the study to the population at large.

The issue of management of lung cancer in older patients has remained out of the limelight for long. Therefore, in view of improving the safety and efficacy of lung cancer management, this article addresses an important and relevant issue.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kapoor A, Noronha V, Patil V, 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
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3.
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. 3
    
4.
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. 4
    
5.
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. 5
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6.
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat 2019;2:232-6.  Back to cited text no. 6
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7.
Mitchell P, Mok T, Barraclough H, Strizek A, Lew R, van Kooten M. Smoking history as a predictive factor of treatment response in advanced non-small-cell lung cancer: A systematic review. Clin Lung Cancer 2012;13:239-51.  Back to cited text no. 7
    
8.
Kucharczuk CR, Ganetsky A, Vozniak JM. Drug-drug interactions, safety, and pharmacokinetics of EGFR tyrosine kinase inhibitors for the treatment of non-small cell lung cancer. J Adv Pract Oncol 2018;9:189-200.  Back to cited text no. 8
    




 

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