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Best care for the oldest lung cancer patients
Date:4/28/2010

A number of phase II and III clinical trials show that single-agent chemotherapy with third-generation agents (vinorelbine, gemcitabine or taxanes) is the routine standard of care in elderly advanced NSCLC patients. The authors performed their own phase I/II trials looking at attenuated doses of cisplatin combined with gemcitabine or vinorelbine in elderly patients with advanced NSCLC. Their results were published in 2007, and in particular show that gemcitabine combined with cisplatin deserves comparison with single agent therapy for this patient group. The researchers are now launching a phase III randomized trial of cisplatin plus gemcitabine versus gemcitabin.

In addition to these chemotherapy treatments, targeted therapies are also available. Oncologists have tested epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, erlotinib and gefitinib, in phase II prospective trials on older patients. They showed that these drugs were a good first line treatment option. The United States Food and Drug Administration (FDA) has recently approved gefitinib for first-line treatment of patients whose tumors are positive for EGFR gene mutations. This means that screening lung cancer patients for EGFR gene mutations will have an important role in decisions about treatment, and will benefit elderly patients, too.

However, another targeted treatment option for the general patient population, using the monoclonal antibody bevacizumab combined with chemotherapy, may be less suitable for the elderly due to their higher likelihood of co-morbid cardiovascular illnesses.

"The lack of data on octogenarians suggest that clinicians should exercise caution when applying the existing data on chemotherapy and targeted therapies for patients aged 70-79 years to those aged over 80 years," the authors stress. "Further specifically designed clinical trials are needed to optimize medical treatment of NSCLC in elderly patients."

Since 2000, oncolog
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Contact: Jayne Fairley
jayne.fairley@sagepub.co.uk
020-732-48719
SAGE Publications UK
Source:Eurekalert

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