Abstract
Background
The survival benefit of first-line epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy in super-elderly patients with advanced non-small cell lung cancer (NSCLC) harboring active EGFR mutations remains unclear.
Methods
We conducted a retrospective evaluation of the difference in the overall survival (OS) among super-elderly (aged ≥ 85 years) NSCLC patients who had received best supportive care alone (BSC group, n = 36), cytotoxic chemotherapy (CT group, n = 11) or EGFR-TKI therapy (TKI group, n = 22).
Results
The median age of the patients was 88 years. Among the 35 super-elderly NSCLC patients with an performance status (PS) score of 0–2, 11of 18 EGFR wild-type patients received cytotoxic chemotherapy and 15 of 17 EGFR-mutant patients received EGFR-TKI therapy with gefitinib (n = 13) or osimertinib (n = 2). The OS tended to be longer in the TKI group than in the CT or BSC group (16.9 months vs. 7.2 months or 9.8 months, p = 0.059). Among the 34 super-elderly NSCLC patients with a PS score of 3–4, 7 with EGFR-mutant received gefitinib therapy and the remaining 27 received BSC alone. The OS tended to be longer in the TKI group than in the BSC group (4.6 months vs. 2.3 months, p = 0.060). Multivariate analysis identified a good PS before the start of first-line therapy and presence of active EGFR mutations reduced a risk of death.
Conclusions
Gefitinib appears to be useful as a salvage therapy in super-elderly NSCLC patients with active EGFR mutation, regardless of their PS.
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References
Asami K et al (2011) Gefitinib as first-line treatment in elderly epidermal growth factor receptor-mutated patients with advanced lung adenocarcinoma: results of a Nagano lung cancer research group study. Clin Lung Cancer 12(6):387–392
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
“Chemotherapy for Elderly Patients With Advanced Non-Small-Cell Lung Cancer: The Multicenter Italian Lung Cancer in the Elderly Study (MILES) Phase III Randomized Trial | JNCI: Journal of the National Cancer Institute | Oxford Academic.” [Online]. Available: https://academic.oup.com/jnci/article/95/5/362/2520632. [Accessed 19May 2020]
Corre R et al (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: The Phase III randomized ESOGIA-GFPC-GECP 08–02 Study. J Clin Oncol 34(13):1476–1483
Ebi N et al (2008) A phase II trial of gefitinib monotherapy in Chemotherapy-Naïve patients of 75 years or older with advanced non-small cell lung cancer. J Thorac Oncol 3(10):1166–1171
“Effects of Vinorelbine on Quality of Life and Survival of Elderly Patients With Advanced Non-Small-Cell Lung Cancer | JNCI: Journal of the National Cancer Institute | Oxford Academic.” [Online]. Available: https://academic.oup.com/jnci/article/91/1/66/2549280. [Accessed: 19-May-2020].
Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25(14):1824–1831
Inoue Y et al (2015) Phase II study of erlotinib in elderly patients with non-small cell lung cancer harboring epidermal growth factor receptor mutations. Cancer Chemother Pharmacol 76(1):155–161
Kobayashi K et al (2009) First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 27(9):1394–1400
Kudoh S et al (2006) Phase III study of docetaxel compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer: results of the West Japan Thoracic Oncology Group trial (WJTOG 9904). J Clin Oncol 24(22):3657–3663
Maemondo M et al (2012) First-line gefitinib in patients aged 75 or older with advanced non-small cell lung cancer harboring epidermal growth factor receptor mutations: NEJ 003 study. J Thorac Oncol 7(9):1417–1422
Maione P et al (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a Prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23(28):6865–6872
Okamoto I et al (2019) Randomized phase III study comparing carboplatin plus pemetrexed followed by pemetrexed versus docetaxel in elderly patients with advanced non-squamous non-small-cell lung cancer (JCOG1210/WJOG7813L). J Clin Oncol 37(15):9031–9031
Quoix E et al (2011) Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet 378(9796):1079–1088
Santos FN, de Castria TB, Cruz MRS, Riera R (2015) “Chemotherapy for advanced non-small cell lung cancer in the elderly population.” Cochrane Database Syst Rev 2015 (10) John Wiley and Sons Ltd
Takahashi K et al (2014) First-line gefitinib therapy for elderly patients with non-small cell lung cancer harboring EGFR mutation: Central Japan Lung Study Group 0901. Cancer Chemother Pharmacol 74(4):721–727
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Kashiwabara, K., Fujii, S., Tsumura, S. et al. Overall survival of super-elderly (85 years or older) advanced non-small cell lung cancer patients with active epidermal growth factor receptor mutations receiving first-line gefitinib therapy: a single-institute retrospective study. J Cancer Res Clin Oncol 147, 287–293 (2021). https://doi.org/10.1007/s00432-020-03344-1
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DOI: https://doi.org/10.1007/s00432-020-03344-1