Lung cancer and treatment in elderly patients: the Achilles Study

The number of elderly patients with cancer continues to increase. Approximately two-thirds of patients diagnosed with non-small cell lung cancer are 65 years, and nearly 50% are 70 years or older. The aim of our study was to discern whether clinical characteristics, toxicity, response rate, treatment and survival are different in patients enrolees 70 years of age and older with those in younger patients.

We reviewed the database of six clinical trials with different doublet combinations in the Spanish Lung Cancer Group from 1998 to 2005. Patient's characteristics, stage, histology, response and survival were obtained.

All 1653 patients were studied; 280 patients (17%) were over 70. No significant differences were found between the two groups with respect to gender, stages, response rate or histological type. However, a greater squamous histological tendency was found in the older group. No differences were found in the median number of cycles administered. The only significant differences were in the greater percentage of grade III/IV neutropenia among patients older than 70. Febrile neutropenia was similar in both groups.

In our study, the oldest age group represented a small percentage of all patients included in clinical and pharmacogenetic trials. Although this might indicate bias when interpreting the results, age is not a contraindication to the treatment of the "fit" elderly. Patients with good performance status can be treated with standard doublets. We believe that special attention should be paid to cases with high risk of neutropenia. Research in this population should now be aimed at finding more selective treatments, based on the genetic differences that older patients have.