Abstract
It is estimated that approximately half of the 500 000 people diagnosed with lung cancer worldwide every year are aged >70 years. Thus, this disease represents a major problem in the elderly and one that will indeed increase as the median age of the population increases. For small cell lung cancer (SCLC), which accounts for approximately 20% of cases of lung cancer, the primary treatment is chemotherapy and in the majority of cases the primary aim is to control the disease which generally would have spread beyond the lungs at the time of presentation. A small number of ‘standard’ chemotherapy regimens (combined with radiotherapy for patients with limited disease) have been shown to improve survival and quality of life and are widely used.
Much of the work investigating the relationship between age and treatment outcomes has been based on clinical trial data and may itself be inherently biased due to trial eligibility criteria excluding elderly patients. However, there is no good evidence that elderly patients fare worse with treatment than their younger counterparts in terms of response rates and survival. Nevertheless with increasing age comes increasing concomitant illnesses which may account for the widely observed increases in drug toxicity, and this may be the primary consideration in selecting the treatment option. Thus for many elderly patients, carboplatin/etoposide may be the treatment of choice because it is perhaps the least toxic of the standard regimens. Whatever regimen is chosen, the key to treatment effectiveness seems to be to deliver the first 3 or 4 cycles without delay or dosage reduction.
Although palliation of symptoms remains a major goal in the treatment of all patients with SCLC there is a dearth of data on whether elderly patients are equally well palliated as their younger counterparts.
There is no good evidence that age per se should be a factor in deciding whether patients should receive standard treatment rather than a more gentle approach, and more elderly patients should be included in clinical trials.
The key areas where more information is required regarding the treatment and outcomes of elderly patients with SCLC are the assessment of palliation, and comprehensive reviews of all patients diagnosed with the disease, not just those included in trials.
Similar content being viewed by others
References
Miller BA, Ries LAG, Hankey BF, et al. Cancer statistics review: 1973–1989. Maryland (MD): National Cancer Institute and National Institutes of Health; 1992. Publication No: 92-2789
Brown JS, Eraut D, Trask C, et al. Age and the treatment of lung cancer. Thorax 1996; 51: 564–8
Messeih AA, Schweitzer JM, Lipton A, et al. Addition of etoposide to cyclophosphamide, doxorubicin, and vincristine for remission induction and survival in patients with small cell lung cancer. Cancer Treat Rep 1987; 71: 61–6
Abratt RP, Salton DGM, Malan JR, et al. A prospective randomised study in limited disease small cell carcinoma: doxorubicin and vincristine plus either cyclophosphamide or etoposide. Eur J Cancer 1995; 31A: 1637–9
Hong WK, Nicaise C, Lawson R, et al. Etoposide combined with cyclophosphamide plus vincristine compared with doxorubicin plus cyclophosphamide plus vincristine and with high-dose cyclophosphamide plus vincristine in the treatment of small-cell carcinoma of the lung: a randomized trial of the Bristol Lung Cancer Study Group. J Clin Oncol 1989; 7: 450–6
Greco FA, Richardson RL, Schulman SF, et al. Treatment of oat cell carcinoma of the lung: complete remissions, acceptable complications, and improved survival. BMJ 1978; 2: 10–1
Bunn PA, Greco FA, Einhorn L. Cyclophosphamide, doxorubicin and etoposide as first-line therapy in the treatment of small-cell lung cancer. Semin Oncol 1986; 13Suppl. 3: 45–53
Einhorn LH, Loehrer PJ. Hoosier Oncology Group Studies in extensive and recurrent small cell lung cancer. Semin Oncol 1995; 22Suppl. 2:28–31
Kosmidis PA, Samantas E, Fountzilas G, et al. Cisplatin/etoposide versus carboplatin/etoposide chemotherapy and irradiation in small cell lung cancer: a randomized phase III study. Semin Oncol 1994; 21Suppl. 6: 23–30
Beith JM, Clarke SJ, Woods RL, et al. Long-term follow-up of a randomised trial of combined chemoradiotherapy induction treatment, with and without maintenance chemotherapy in patients with small cell carcinoma of the lung. Eur J Cancer 1996; 32A: 438–43
Ihde DC, Mulshine JL, Kramer BS, et al. Prospective randomized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small cell lung cancer. J Clin Oncol 1994; 12: 2022–34
Fukuoka M, Furuse K, Saijo N, et al. Randomized trial of cyclophosphamide, doxorubicin and vincristine versus cisplatin and etoposide versus alternation of these regimens in small-cell lung cancer. J Natl Cancer Inst 1991; 83: 855–61
Roth BJ, Johnson DH, Einhorn LH, et al. Randomized study of cyclophosphamide, doxorubicin and vincristine versus etoposide and cisplatin versus alternation of these two regimens in extensive small-cell lung cancer: a phase III trial of the Southeastern Cancer Study Group. J Clin Oncol 1992; 10: 282–91
Evans WK, Feld R, Murray N, et al. Superiority of alternating non-cross-resistant chemotherapy in extensive small cell lung cancer. Ann Intern Med 1987; 107: 451–8
Smith IE, Evans BD, Gore ME, et al. Carboplatin (paraplatin; JM8) and etoposide (VP-16) as first-line combination therapy for small-cell lung cancer. J Clin Oncol 1987; 5: 185–9
Viren M, Liippo K, Ojala A, et al. Carboplatin and etoposide in extensive small cell lung cancer. Acta Oncol 1994; 33: 921–4
Bishop JF, Raghavan D, Stuart-Harris R, et al. Carboplatin (CBDCA, JM-8) and VP-16-213 in previously untreated patients with small-cell lung cancer. J Clin Oncol 1987; 5: 1574–8
Birch R, Weaver CH, Hainsworth JD, et al. A randomized study of etoposide and carboplatin with or without paclitaxel in the treatment of small cell lung cancer. Semin Oncol 1997; 24Suppl. 12: 135–7
Jones AL, Holborn J, Ashley S, et al. Effective new low toxicity chemotherapy with carboplatin, vinblastine and methotrexate for small cell lung cancer: a randomized trial against doxorubicin, cyclophosphamide and etoposide. Eur J Cancer 1991; 27: 866–70
Thatcher N, Sambrook RJ, Stephens RJ, et al. Dose intensification (DI) with G-CSF improves survival in small cell lung cancer (SCLC): results of a randomized trial [abstract 1754]. Proc Am Soc Clin Oncol 1997; 17: 456a
Matelski HW, Lokich JJ, Huberman MS, et al. Adriamycin, cyclophosphamide, and etoposide (VP-16-213) in extensive-stage small cell lung cancer. Am J Clin Oncol 1984; 7: 729–32
Jackson DV, Zekan PJ, Caldwell RD, et al. VP-16-213 in combination chemotherapy with chest irradiation for small-cell lung cancer: a randomized trial of the Piedmont Oncology Association. J Clin Oncol 1984; 2: 1343–51
Goodman GE, Crowley JJ, Blasko JC, et al. Treatment of limited small-cell lung cancer with etoposide and cisplatin alternating with vincristine, doxorubicin, and cyclophosphamide versus concurrent etoposide, vincristine, doxorubicin and cyclophosphamide and chest radiotherapy: a Southwest Oncology Group study. J Clin Oncol 1990; 8: 39–47
Murray N, Shah A, Osoba D, et al. Intensive weekly chemotherapy for the treatment of extensive-stage small-cell lung cancer. J Clin Oncol 1991; 9: 1632–8
Murray N, Livingstone R, Shepherd F, et al. Randomized study of CODE versus alternating CAV/EP for extensive stage small cell lung cancer: an intergroup study of the National Cancer Institute of Canada Clinical Trials group and the Southwest Oncology Group. J Clin Oncol 1999; 17: 2300–8
Fukuoka M, Masuda N, Negoro S, et al. CODE chemotherapy with and without granulocyte colony-stimulating factor in small-cell lung cancer. Br J Cancer 1997; 75: 306–9
Hainsworth JD, Hopkins LG, Thomas M, Greco FA. Paclitaxel, carboplatin and extended schedule oral daily etoposide for small cell lung cancer. Oncology 1998; 12 (1 Suppl. 2): 31–5
Hainsworth JD, Greco FA. The current role and future prospects of paclitaxel in the treatment of small cell lung cancer. Semin Oncol 1999; 26Suppl. 2: 60–6
Murray N. Importance of dose and dose intensity in the treatment of small-cell lung cancer. Cancer Chemother Pharmacol 1997; 40 Suppl.: S58–63
Amagada R, Le Chevalier T, Pignon JP, et al. Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. N Engl J Med 1993; 329: 1848–52
Pignon JP, Amagada R, Ihde DC, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992; 327: 1618–24
Murray N, Coy P, Pater JL, et al. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. J Clin Oncol 1993; 11: 336–44
Jeremic B, Shibamoto Y, Acimovic L, et al. Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small-cell lung cancer: a randomized study. J Clin Oncol 1997; 15: 893–900
Work E, Nielsen OS, Bentzen SM, et al. Randomized study of initial versus late chest irradiation combined with chemotherapy in limited-stage small-cell lung cancer. J Clin Oncol 1997; 15: 3030–7
Perry MC, Eaton WL, Propert KJ, et al. Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 1987; 316: 912–8
Goto K, Nishiwaki Y, Takada M, et al. Final results of a phase III study of concurrent vs sequential thoracic radiotherapy (TRT) in combination with cisplatin (P) and etoposide (E) for limited stage small cell lung cancer (LD SCLC): the Japan Clinical Oncology Group (JCOG) study [abstract 1805]. Proc Am Soc Clin Oncol 1999; 18: 468a
Auperin A, Amagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission. N Engl J Med 1999; 341: 476–84
Cull A, Gregor A, Hopwood P, et al. Neurological and cognitive impairment in long term survivors of small cell lung cancer. Eur J Cancer 1994; 30A: 1067–74
Andersen M, Kristjansen PE, Hansen HH. Second-line chemotherapy in small cell lung cancer. Cancer Treat Rev 1990; 17: 427–36
Ardizzoni A, Hansen H, Dombernowsky P, et al. Topotecan, a new active drug in the second-line treatment of small-cell lung cancer: a phase II study in patients with refectory and sensitive disease. J Clin Oncol 1997; 15: 2090–6
Tummarello D, Guidi F, Torresi U, et al. Teniposide (VM26) as second-line treatment for small cell lung cancer. Anticancer Res 1990; 10: 397–9
Falk SJ, Maughan TS, Laurence VM, et al. Phase II study of carboplatin and adriamycin as second line chemotherapy in small cell lung cancer. Clin Oncol (R Coll Radiol) 1993; 5: 85–8
Postmus PE, Smit EF, Berendsen HH, et al. Second-line carboplatin-based chemotherapy small cell lung cancer: the Groningen experience. Semin Oncol 1992; 19Suppl. 2: 17–23
Ebi N, Kubota K, Nishiwaki, et al. Second-line chemotherapy for relapsed small cell lung cancer. Jpn J Clin Oncol 1997; 27: 166–9
Dajczman E, Fu LY, Small D, et al. Treatment of small cell lung carcinoma in the elderly. Cancer 1996; 77: 2032–8
Tebbutt NC, Snyder RD, Burns WI. An analysis of the outcomes of treatment of small cell lung cancer in the elderly. Aust N Z J Med 1997; 27: 160–4
Shepherd FA, Amdemichael E, Evans WK, et al. Treatment of small cell lung cancer in the elderly. J Am Geriatr Soc 1994; 42: 64–70
Clamon GH, Audeh MW, Pinnick S. Small cell lung carcinoma in the elderly. J Am Geriatr Soc 1982; 30: 299–302
Siu LL, Shepherd FA, Murray N, et al. Influence of age on the treatment of limited-stage small-cell lung cancer. J Clin Oncol 1996; 14: 821–8
Paccagnella A, Favaretto A, Cipriani A, et al. Treatment of small cell lung cancer (SCLC) in elderly patients [abstract 1164]. Proc Am Soc Clin Oncol 1996; 15: 387
Medical Research Council Lung Cancer Working Party. Randomised trial of four-drug vs less intensive two-drug chemotherapy in the palliative treatment of patients with small-cell lung cancer (SCLC) and poor prognosis. Br J Cancer 1996; 73: 406–13
Medical Research Council Lung Cancer Working Party. Comparison of oral etoposide and standard intravenous multidrug chemotherapy for small-cell lung cancer: a stopped multicentre randomised trial. Lancet 1996; 348: 563–6
De Haes JCJ, Knippenberg FCE, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer 1990; 62: 1034–8
Teeter SM, Holmes FF, McFarlane MJ. Lung carcinoma in the elderly population. Cancer 1987; 60: 1331–6
Suen KC, Lau LL, Yermakov V. Cancer and old age: an autopsy study of 3535 patients over 65 years old. Cancer 1974; 3: 1164–8
Holmes FF. Clinical evidence for a change in tumor aggressiveness with age. Semin Oncol 1989; 16: 34–40
O’Rourke MA, Feussner JR, Feigl P, et al. Age trends of lung cancer stage at diagnosis. JAMA 1987; 258: 921–6
Muers MF, Haward RA. Management of lung cancer. Thorax 1996; 51: 557–60
Guadagnoli E, Weitberg A, Mor V, et al. The influence of patient age on the diagnosis and treatment of lung and colorectal cancer. Arch Intern Med 1990; 150: 1485–90
Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses and general public. BMJ 1990; 300: 1458–60
Raby B, Pater J, Mackillop WJ. Does knowledge guide practice? Another look at the management of non-small cell lung cancer. J Clin Oncol 1995; 13: 1904–11
Kennedy BJ. Aging and cancer. J Clin Oncol 1988; 6: 1903–11
Hrushesky WJM, Slump W, Kennedy BJ. Lack of age-dependent cisplatin neurotoxicity. Am J Med 1984; 76: 579–84
Walsh SJ, Begg CB, Carbone PP. Cancer chemotherapy in the elderly. Semin Oncol 1989; 16: 66–75
Nerenz DR, Love RR, Leventhal H, et al. Psychosocial consequences of cancer chemotherapy for elderly patients. Health Services Res 1986; 20: 961–76
Ganz PA, Schag CC, Heinrich RL. The psychosocial impact of cancer on the elderly: a comparison with younger patients. J Am Geriatr Soc 1985; 33: 429–35
Silvestri G, Pritchard R, Welch HG. Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 1998; 317: 771–5
Goss GD, Logan D, Maroun J, et al. Chemotherapy in elderly patients with small cell lung cancer (SCLC) [abstract 969]. Proc Am Soc Clin Oncol 1992; 11: 290
Keane M, Carney DN. Treatment of elderly patients with small cell lung cancer. Lung Cancer 1993; 9Suppl. 1: S91–8
Zagonel V, Tirelli U, Serraino D, et al. The aged patient with lung cancer: management recommendations. Drugs Aging 1994; 4: 34–46
Hansen M, Hirsch F, Dombernowsky P, et al. Treatment of small cell anaplastic carcinoma of the lung with the oral solution of VP-16-213 (NSC 141540, 4′demethlepipodophyllotoxin 9-(4, 6-0-ethylidene-β-D-glucopyranoside). Cancer 1977; 40: 633–7
Dorward AJ. A prospective study of low dose oral etoposide in poor prognosis small cell lung cancer (SCLC) [abstract]. Cancer Treat Res 1991; 7: 111
Postmus PE, Smit EF, Berendsen HH. Phase II study of daily oral etoposide (OE) on a 5-week schedule in elderly patients (pts) with small cell lung cancer (SCLC) [abstract]. Ann Oncol 1990; 1 Suppl.: 54
Cavalli F, Sonntag RW, Jungi F, et al. VP-16-213 monotherapy for remission induction of small cell lung cancer: a randomised trial using three dosage schedules. Cancer Treat Rep 1978; 62: 473–5
Slevin ML, Clark PI, Joel S, et al. Arandomized trial to evaluate the effect of schedule on the activity of etoposide in small-cell lung cancer. J Clin Oncol 1989; 7: 1333–40
Smit EF, Carney DN, Harford P, et al. A phase II study of oral etoposide in elderly patients with small cell lung cancer. Thorax 1989; 44: 631–3
Carney DN, Byrne A. Etoposide in the treatment of elderly/poor-prognosis patients with small-cell lung cancer. Cancer Chemother Pharmacol 1994; 34 Suppl.: S96–100
Bork E, Hansen M, Dombernowsky P, et al. Teniposide (VM-26), an overlooked highly active agent in small-cell lung cancer: results of a phase II trial in untreated patients. J Clin Oncol 1986; 4: 524–7
Holoye PY, Winn RJ, Craig K, et al. Phase II study of teniposide in small cell bronchogenic carcinoma [abstract 946]. Proc Am Soc Clin Oncol 1989; 8: 243
Tummarello D, Isidori P, Pasini F, et al. Teniposide as single drug therapy for elderly patients affected by small cell lung cancer. Eur J Cancer 1992; 28A: 1081–4
Cerny T, Pedrazzini A, Joss RA, et al. Unexpected high toxicity in a phase II study of teniposide (VM-26) in elderly patients with untreated small cell lung cancer (SCLC). Eur J Cancer 1988; 24: 1791–4
Giaccone G, Donadio M, Bonardi G, et al. Teniposide in the treatment of small-cell lung cancer: the influence of prior chemotherapy. J Clin Oncol 1988; 6: 1264–70
Cascinu S, Del Ferro E, Ligi M, et al. The clinical impact of teniposide in the treatment of elderly patients with small-cell lung cancer. Am J Clin Oncol 1997; 20: 477–8
Manegold C, Loechner S, Bachmann P, et al. Oral ifosphamide in elderly and/or unfit patients with small-cell lung cancer (SCLC): a phase II study [abstract]. Ann Oncol 1992; 3Suppl. 5:38
Quoix EA, Giaccone G, Jassem J, et al. Epirubicin in previously untreated patients with small cell lung cancer: a phase II study by the EORTC lung cancer cooperative group. Eur J Cancer 1992; 28A: 1667–70
Smith IE, Evans BD. Carboplatin (JM8) as a single agent and in combination in the treatment of small cell lung cancer. Cancer Treat Rev 1985; 12Suppl. A: 73–5
Bork E, Ersboll J, Dombernowsky P, et al. Teniposide and etoposide in previously untreated small-cell lung cancer: a randomized study. J Clin Oncol 1991; 9: 1627–31
Ettinger D, Finkelstein D, Ritch P, et al. Randomized trial of single agents vs combination chemotherapy in extensive stage small cell lung cancer (SCLC) [abstract 988]. Proc Am Soc Clin Oncol 1992; 11: 295
Souhami RL, Spiro SG, Rudd RM, et al. Five-day oral etoposide treatment for advanced small-cell lung cancer: randomized comparison with intravenous chemotherapy. J Natl Cancer Inst 1997; 89: 577–80
Byrne A, Carney DN. Small cell lung cancer in the elderly. Semin Oncol 1994; 21Suppl. 6: 43–8
Evans WK, Radwi A, Tomiak E, et al. Oral etoposide and carboplatin: effective therapy for elderly patients with small cell lung cancer. Am J Clin Oncol 1995; 18: 149–55
Matsui K, Masuda N, Takada M, et al. Phase II trial of carboplatin (CBDCA) plus oral etoposide (ETP) for elderly patients with small cell lung cancer (SCLC) [abstract 1157]. Proc Am Soc Clin Oncol 1996; 15: 385
Michel G, Leyvraz S, Bauer J, et al. Weekly carboplatin and VM-26 for elderly patients with small-cell lung cancer. Ann Oncol 1994; 5: 369–70
Allan SG, Gregor A, Cornbleet MA, et al. Phase II trial of vindesine and VP16-213 in the palliation of poor-prognosis patients and elderly patients with small cell lung cancer. Cancer Chemother Pharmacol 1984; 13: 106–8
Westeel V, Murray N, Gelmon K, et al. New combination of the old drugs for elderly patients with small-cell lung cancer: a phase II study of the PAVE regimen. J Clin Oncol 1998; 16: 1940–7
Radford JA, Ryder WDJ, Dodwell D, et al. Predicting septic complications of chemotherapy: an analysis of 382 patients treated for small cell lung cancer without dose reduction after major sepsis. Eur J Cancer 1993; 29A: 81–6
Stephens RJ, Girling DJ, Machin D. Treatment-related deaths in small cell lung cancer trials: can patients at risk be identified? Lung Cancer 1994; 11: 259–74
Lyman GH, Lyman CG, Sanderson RA, et al. Decision analysis of hematopoietic growth factor use in patients receiving cancer chemotherapy. J Natl Cancer Inst 1993; 85: 488–93
Nichols CR, Fox EP, Roth BJ, et al. Incidence of neutropenic fever in patients treated with standard-dose combination chemotherapy for small-cell lung cancer and the cost impact of treatment with granulocyte colony-stimulating factor. J Clin Oncol 1994; 12: 1245–50
Raghavan D, Bishop JF, Stuart-Harris R, et al. Carboplatin-containing regimens for small call lung cancer: implications for management in the elderly. Semin Oncol 1992; 1Suppl. 2: 12–6
Matsui K, Takada M, Masuda N, et al. Pilot study of carboplatin (CBDCA) calculated by Egorin’s formula plus oral etoposide (ETP) for elderly patients with small cell lung cancer (SCLC) [abstract 1179]. Proc Am Soc Clin Oncol 1994; 13: 352
Skarlos DV, Samantas E, Kosmidis P, et al. Randomized comparison of etoposide-cisplatin vs etoposide-carboplatin and irradiation in small-cell lung cancer: a Hellenic Cooperative Oncology Group study. Ann of Oncol 1994; 5: 601–7
Bishop JF. Carboplatin/etoposide in small cell lung cancer. Oncology 1992; 49Suppl. 1: 11–8
Shibata K, Nakatsumi Y, Kasahara K, et al. Analysis of thrombocytopenia due to carboplatin combined with etoposide in elderly patients with lung cancer. J Cancer Res Clin Oncol 1996; 122: 437–42
Murray N, Grafton C, Shah A, et al. Abbreviated treatment for elderly, infirm, or noncompliant patients with limited stage small-cell lung cancer. J Clin Oncol 1998; 16: 3323–8
Jeremic B, Shibamoto Y, Acimovic L, et al. Carboplatin, etoposide and accelerated hyperfractionated radiotherapy for elderly patients with limited small cell lung carcinoma: a phase II study. Cancer 1998; 82: 836–41
Turrisi A, Kim K, Sause W, et al. Observations after 5-year follow-up of intergroup trial 0096: 4 cycles of cisplatin (P) etoposide (E) and concurrent 45 GY thoracic radiotherapy (TRT) given in daily (QD) or twice-daily fractions followed by 25 GY PCI. Survival differences and patterns of failure [abstract 1757]. Proc Am Soc Clin Oncol 1998; 17: 457a
Yuen A, Zou G, Turissi A, et al. Similar outcome of elderly patients in intergroup trial 0096: cisplatin (P), etoposide (E), and thoracic radiotherapy (TRT) administered once (QD) or twice daily (BID) in limited stage small cell lung cancer (SCLC) [abstract 1803]. Proc Am Soc Clin Oncol 1999; 18: 467a
Quon H, Shepherd FA, Payne DG, et al. The influence of age on the delivery, tolerance, and efficacy of thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer. Int J Radiat Oncol Biol Phys 1999; 43: 39–45
Zagonel V, Fratino L, Sacco C, et al. Reducing chemotherapy-associated toxicity in elderly cancer patients. Cancer Treat Rev 1996; 22: 223–44
Shank WA, Balducci L. Recombinant hemopoietic growth factors: comparative hemopoietic response in younger and older subjects. J Am Geriatr Soc 1992; 40: 151–4
Maslak P, Nimer SD. The efficacy of IL-3, SCF, IL-6 and IL-11 in treating thrombocytopenia. Semin Haematol 1998; 35: 253–60
Abels RI. Use of recombinant human erythropoietin in the treatment of anaemia in patients who have cancer. Semin Oncol 1992; 19: 29–35
Caprizzi RL. Clinical status and optimal use of amifostine. Oncology 1999; 13: 47–59
Markman M. Amifostine in reducing cisplatin toxicity. Semin Oncolol 1998; 25: 522–4
Niiranen A, Kajanti M, Tammilehto L, et al. The clinical effect of medroxyprogesterone (MPA) in elderly patients with lung cancer. Am J Clin Oncol 1990; 13: 113–6
Begg CB, Carbone PP. Clinical trials and drug toxicity in the elderly: the experience of the Eastern Cooperative Oncology Group. Cancer 1983; 52: 1986–92
Ohnoshi T, Ueoka H, Hino N, et al. Treatment of small cell lung cancer in the elderly: the progress and limitation of chemotherapy. Nihon Kyobo Shikkan Gakkai Zasshi 1992; 30: 216–23
Nou E. Full chemotherapy in elderly patients with small cell bronchial carcinoma. Acta Oncol 1996; 35: 399–406
Kelly P, O’Brien AAJ, Daly P, et al. Small-cell lung cancer in elderly patients: the case for chemotherapy. Age Aging 1991; 20: 19–22
Vincent MD, Ashley SE, Smith IE. Prognostic factors in small cell lung cancer: a simple prognostic index is better than conventional staging. Eur J Cancer Clin Oncol 1987; 23: 1589–99
Cerny T, Blair V, Anderson H, et al. Pretreatment prognostic factors and scoring system in 407 small-cell lung cancer patients. Int J Cancer 1987; 39: 146–9
Rawson NSB, Peto J. An overview of prognostic factors in small cell lung cancer: a report from the subcommittee for the management of lung cancer of the United Kingdom Coordinating Committee on Cancer Research. Br J Cancer 1990; 61: 597–604
Sagman U, Maki E, Evans WK, et al. Small-cell carcinoma of the lung: derivation of a prognostic staging system. J Clin Oncol 1991; 9: 1639–49
Medical Research Council Lung Cancer Working Party. A randomised trial of three or six courses of etoposide cyclophosphamide, methotrexate and vincristine or six courses of etoposide and ifosphamide in small cell lung cancer (SCLC) I: survival and prognostic factors. Br J Cancer 1993; 68: 1150–6
Kawahara M, Fukuoka M, Saijo N, et al. Prognostic factors and prognostic staging system for small cell lung cancer. Jpn J Clin Oncol 1997; 27: 158–65
Maestu I, Pastor M, Gomez-Codina J, et al. Pretreatment prognostic factors for survival in small-cell lung cancer: a new prognostic index and validation of three known prognostic indicies on 341 patients. Ann Oncol 1997; 8: 547–53
Tamura M, Ueoka H, Kiura K, et al. Prognostic factors of small-cell lung cancer in Okayama Lung Cancer Study Group trials. Acta Med Okayama 1998; 52: 105–11
Albain KS, Crowley JJ, LeBlanc M, et al. Determinants of improved outcome in small-cell lung cancer: an analysis of the 2580-patient Southwest Oncology Group data base. J Clin Oncol 1990; 8: 1563–74
Spiegelman D, Maurer LH, Ware JH, et al. Prognostic factors in small-cell carcinoma of the lung: an analysis of 1521 patients. J Clin Oncol 1989; 7: 344–54
Osterlind K, Andersen PK. Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. Cancer Res 1986; 46: 4189–94
Maurer LH, Pajak TF. Prognostic factors in small cell carcinoma of the lung: a Cancer and Leukemia Group B study. Cancer Treat Rep 1981; 65: 767–74
Wolf M, Holle R, Hans K, et al. Analysis of prognostic factors in 766 patients with small cell lung cancer (SCLC): the role of sex as a predictor for survival. Br J Cancer 1991; 63: 986–92
Stephens RJ, Hopwood P, Girling DJ. Defining and analysing symptom palliation in cancer clinical trials: a deceptively difficult exercise. Br J Cancer 1999; 79: 538–44
Poplin E, Thompson B, Whitacre M, et al. Small cell carcinoma of the lung: influence of age on treatment outcome. Cancer Treat Rep 1987; 71: 291–6
Armitage JO, Potter JF. Aggressive chemotherapy for diffuse histiocytic lymphoma in the elderly: increased complications with advancing age. J Am Geriatr Soc 1984; 32: 269–73
Balducci L, Parker M, Sexton W, et al. Pharmacology of antineoplastic agents in the elderly patient. Semin Oncolol 1989; 16: 76–84
Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents. Semin Oncolol 1992; 19: 566–79
Tuxen MK, Hansen SW. Neurotoxicity secondary to antineoplastic drugs. Cancer Treat Rev 1994; 20: 191–214
Thyss A, Saudes L, Otto J, et al. Renal tolerance of cisplatin in patients more than 80 years old. J Clin Oncol 1994; 12: 2121–5
Patterson WP, Reams GP. Renal toxicities of chemotherapy. Semin Oncolol 1992; 19: 521–8
Findlay MPN, Griffin AM, Raghavan D, et al. Retrospective review of chemotherapy for small cell lung cancer in the elderly: does the end justify the means? Eur J Cancer 1991; 27: 1597–601
Joel SP, Clark PI, Slevin ML. Risk factors which predict for haematological toxicity with etoposide [abstract B4]. Br J Cancer 1992; 65Suppl. 16: 11
Fretwell M. The consensus conference on Comprehensive Geriatric Assessment: a dialogue is the beginning of consensus. J Am Geriatr Soc 1988; 36: 377–9
Monfardini S, Ferrucci L, Fratino L, et al. Validation of a Multidimensional Evaluation Scale for use in elderly cancer patients. Cancer 1996; 77: 395–401
Morittu L, Earl HM, Souhami RL, et al. Patients at risk of chemotherapy-associated toxicity in small cell lung cancer. Br J Cancer 1989; 59: 801–4
Samet J, Hunt WC, Key C, et al. Choice of cancer therapy varies with age of patient. JAMA 1986; 255: 3385–90
Sambrook RJ, Girling DJ. A national survey of chemotherapy (CT) in small cell lung cancer (SCLC) [abstract S54]. Thorax 1999; 54Suppl. 3: A14
Zagonel V, Pinto A, Serraino D, et al. Lung cancer in the elderly. Cancer Treat Rev 1994; 20: 315–29
Trimble EL, Carter CL, Cain D, et al. Representation of older patients in cancer treatment trials. Cancer 1994; 74 (7 Suppl.): 2208–14
Hutchins LF, Unger JM, Crowley JJ, et al. Under-representation of patients 65 year of age or older in cancer treatment trials. N Engl J Med 1999; 341: 2061–7
Brundage MD, Davidson JR, Mackillop WJ. Trading treatment toxicity for survival in locally advanced non-small lung cancer. J Clin Oncol 1997; 15: 330–40
Zagonel V, Tirelli U. Age as a risk factor for inadequate treatment [letter]. JAMA 1988; 259: 41
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stephens, R.J., Johnson, D.H. Treatment and Outcomes for Elderly Patients with Small Cell Lung Cancer. Drugs & Aging 17, 229–247 (2000). https://doi.org/10.2165/00002512-200017030-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-200017030-00006