Small-cell Lung Cancer in Very Elderly (≥ 80 Years) Patients

Steven E. Schild, Liming Zhao, Jason A. Wampfler, Thomas B. Daniels, Terence Sio, Helen J Ross, Harshita Paripati, Randolph Stuart Marks, Joanne Yi, Han Liu, Yanqi He, Ping Yang

Research output: Contribution to journalArticle

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Abstract

Background: This analysis was performed to describe the outcome of very elderly (≥ 80 years) patients with small-cell lung cancer (SCLC) as there is no published data regarding these patients. Materials and Methods: One hundred forty-six very elderly patients with SCLC were identified from the Institutional Lung Cancer Database ranging in age from 80 to 92 years (median, 82 years). Of these, 47 (32%) patients had limited-stage SCLC (L-SCLC), and 99 (68%) had extensive-stage SCLC (E-SCLC). All were Caucasian, and the majority (64%) were female. Sixty-seven (46%) patients had Zubrod performance status (PS) of 0 to 1. Results: Of the 146 patients, 44 (30%) received no therapy, 65 (45%) received chemotherapy alone, 27 (19%) received chemotherapy plus local therapy (thoracic radiotherapy [TRT] or surgery), and 10 (7%) received local therapy alone. The median survival was 5.4 months. On univariable analysis, age (P = .019), stage (L-SCLC vs. E-SCLC; P = .0002), PS (P < .0001), and treatment option (P < .0001) were associated with survival. On multivariable analysis, stage (P = .011), PS (P = .029), and treatment option (P < .0001) maintained significance. For entire cohort, the median survival was 1.3 months without active therapy, 6 months with local therapy alone, 7.2 months with chemotherapy alone, and 14.4 months with chemotherapy plus local therapy (P < .0001, univariable and multivariable). Similar survival findings in response to treatment were found when the L-SCLC and E-SCLC cohorts were separately analyzed. Conclusions: The survival of very elderly patients with SCLC was associated with stage (L-SCLC vs. E-SCLC), PS, and treatment option. Very elderly patients with SCLC often have limited functional reserve required to tolerate aggressive multimodality therapy but appeared to benefit from it. Geriatric assessments, careful monitoring, and extra support are warranted in elderly patients. Care should be individualized based on the desires and needs of each patient. This study found that the survival of very elderly (≥ 80 years) patients with small-cell lung cancer was associated with stage, performance status, and treatment option. Very elderly patients with small-cell lung cancer are a growing patient population who have not been previously reported on. Future progress will require trials specific to the elderly, integration of immunotherapy, greater supportive care, better geriatric assessment, and less toxic regimens.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StatePublished - Jan 1 2019

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Small Cell Lung Carcinoma
Survival
Therapeutics
Geriatric Assessment
Drug Therapy
Poisons
Immunotherapy
Lung Neoplasms
Radiotherapy
Thorax

Keywords

  • Chemotherapy
  • Radiation therapy
  • Resection
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Small-cell Lung Cancer in Very Elderly (≥ 80 Years) Patients. / Schild, Steven E.; Zhao, Liming; Wampfler, Jason A.; Daniels, Thomas B.; Sio, Terence; Ross, Helen J; Paripati, Harshita; Marks, Randolph Stuart; Yi, Joanne; Liu, Han; He, Yanqi; Yang, Ping.

In: Clinical Lung Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Schild, Steven E. ; Zhao, Liming ; Wampfler, Jason A. ; Daniels, Thomas B. ; Sio, Terence ; Ross, Helen J ; Paripati, Harshita ; Marks, Randolph Stuart ; Yi, Joanne ; Liu, Han ; He, Yanqi ; Yang, Ping. / Small-cell Lung Cancer in Very Elderly (≥ 80 Years) Patients. In: Clinical Lung Cancer. 2019.
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abstract = "Background: This analysis was performed to describe the outcome of very elderly (≥ 80 years) patients with small-cell lung cancer (SCLC) as there is no published data regarding these patients. Materials and Methods: One hundred forty-six very elderly patients with SCLC were identified from the Institutional Lung Cancer Database ranging in age from 80 to 92 years (median, 82 years). Of these, 47 (32{\%}) patients had limited-stage SCLC (L-SCLC), and 99 (68{\%}) had extensive-stage SCLC (E-SCLC). All were Caucasian, and the majority (64{\%}) were female. Sixty-seven (46{\%}) patients had Zubrod performance status (PS) of 0 to 1. Results: Of the 146 patients, 44 (30{\%}) received no therapy, 65 (45{\%}) received chemotherapy alone, 27 (19{\%}) received chemotherapy plus local therapy (thoracic radiotherapy [TRT] or surgery), and 10 (7{\%}) received local therapy alone. The median survival was 5.4 months. On univariable analysis, age (P = .019), stage (L-SCLC vs. E-SCLC; P = .0002), PS (P < .0001), and treatment option (P < .0001) were associated with survival. On multivariable analysis, stage (P = .011), PS (P = .029), and treatment option (P < .0001) maintained significance. For entire cohort, the median survival was 1.3 months without active therapy, 6 months with local therapy alone, 7.2 months with chemotherapy alone, and 14.4 months with chemotherapy plus local therapy (P < .0001, univariable and multivariable). Similar survival findings in response to treatment were found when the L-SCLC and E-SCLC cohorts were separately analyzed. Conclusions: The survival of very elderly patients with SCLC was associated with stage (L-SCLC vs. E-SCLC), PS, and treatment option. Very elderly patients with SCLC often have limited functional reserve required to tolerate aggressive multimodality therapy but appeared to benefit from it. Geriatric assessments, careful monitoring, and extra support are warranted in elderly patients. Care should be individualized based on the desires and needs of each patient. This study found that the survival of very elderly (≥ 80 years) patients with small-cell lung cancer was associated with stage, performance status, and treatment option. Very elderly patients with small-cell lung cancer are a growing patient population who have not been previously reported on. Future progress will require trials specific to the elderly, integration of immunotherapy, greater supportive care, better geriatric assessment, and less toxic regimens.",
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author = "Schild, {Steven E.} and Liming Zhao and Wampfler, {Jason A.} and Daniels, {Thomas B.} and Terence Sio and Ross, {Helen J} and Harshita Paripati and Marks, {Randolph Stuart} and Joanne Yi and Han Liu and Yanqi He and Ping Yang",
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T1 - Small-cell Lung Cancer in Very Elderly (≥ 80 Years) Patients

AU - Schild, Steven E.

AU - Zhao, Liming

AU - Wampfler, Jason A.

AU - Daniels, Thomas B.

AU - Sio, Terence

AU - Ross, Helen J

AU - Paripati, Harshita

AU - Marks, Randolph Stuart

AU - Yi, Joanne

AU - Liu, Han

AU - He, Yanqi

AU - Yang, Ping

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: This analysis was performed to describe the outcome of very elderly (≥ 80 years) patients with small-cell lung cancer (SCLC) as there is no published data regarding these patients. Materials and Methods: One hundred forty-six very elderly patients with SCLC were identified from the Institutional Lung Cancer Database ranging in age from 80 to 92 years (median, 82 years). Of these, 47 (32%) patients had limited-stage SCLC (L-SCLC), and 99 (68%) had extensive-stage SCLC (E-SCLC). All were Caucasian, and the majority (64%) were female. Sixty-seven (46%) patients had Zubrod performance status (PS) of 0 to 1. Results: Of the 146 patients, 44 (30%) received no therapy, 65 (45%) received chemotherapy alone, 27 (19%) received chemotherapy plus local therapy (thoracic radiotherapy [TRT] or surgery), and 10 (7%) received local therapy alone. The median survival was 5.4 months. On univariable analysis, age (P = .019), stage (L-SCLC vs. E-SCLC; P = .0002), PS (P < .0001), and treatment option (P < .0001) were associated with survival. On multivariable analysis, stage (P = .011), PS (P = .029), and treatment option (P < .0001) maintained significance. For entire cohort, the median survival was 1.3 months without active therapy, 6 months with local therapy alone, 7.2 months with chemotherapy alone, and 14.4 months with chemotherapy plus local therapy (P < .0001, univariable and multivariable). Similar survival findings in response to treatment were found when the L-SCLC and E-SCLC cohorts were separately analyzed. Conclusions: The survival of very elderly patients with SCLC was associated with stage (L-SCLC vs. E-SCLC), PS, and treatment option. Very elderly patients with SCLC often have limited functional reserve required to tolerate aggressive multimodality therapy but appeared to benefit from it. Geriatric assessments, careful monitoring, and extra support are warranted in elderly patients. Care should be individualized based on the desires and needs of each patient. This study found that the survival of very elderly (≥ 80 years) patients with small-cell lung cancer was associated with stage, performance status, and treatment option. Very elderly patients with small-cell lung cancer are a growing patient population who have not been previously reported on. Future progress will require trials specific to the elderly, integration of immunotherapy, greater supportive care, better geriatric assessment, and less toxic regimens.

AB - Background: This analysis was performed to describe the outcome of very elderly (≥ 80 years) patients with small-cell lung cancer (SCLC) as there is no published data regarding these patients. Materials and Methods: One hundred forty-six very elderly patients with SCLC were identified from the Institutional Lung Cancer Database ranging in age from 80 to 92 years (median, 82 years). Of these, 47 (32%) patients had limited-stage SCLC (L-SCLC), and 99 (68%) had extensive-stage SCLC (E-SCLC). All were Caucasian, and the majority (64%) were female. Sixty-seven (46%) patients had Zubrod performance status (PS) of 0 to 1. Results: Of the 146 patients, 44 (30%) received no therapy, 65 (45%) received chemotherapy alone, 27 (19%) received chemotherapy plus local therapy (thoracic radiotherapy [TRT] or surgery), and 10 (7%) received local therapy alone. The median survival was 5.4 months. On univariable analysis, age (P = .019), stage (L-SCLC vs. E-SCLC; P = .0002), PS (P < .0001), and treatment option (P < .0001) were associated with survival. On multivariable analysis, stage (P = .011), PS (P = .029), and treatment option (P < .0001) maintained significance. For entire cohort, the median survival was 1.3 months without active therapy, 6 months with local therapy alone, 7.2 months with chemotherapy alone, and 14.4 months with chemotherapy plus local therapy (P < .0001, univariable and multivariable). Similar survival findings in response to treatment were found when the L-SCLC and E-SCLC cohorts were separately analyzed. Conclusions: The survival of very elderly patients with SCLC was associated with stage (L-SCLC vs. E-SCLC), PS, and treatment option. Very elderly patients with SCLC often have limited functional reserve required to tolerate aggressive multimodality therapy but appeared to benefit from it. Geriatric assessments, careful monitoring, and extra support are warranted in elderly patients. Care should be individualized based on the desires and needs of each patient. This study found that the survival of very elderly (≥ 80 years) patients with small-cell lung cancer was associated with stage, performance status, and treatment option. Very elderly patients with small-cell lung cancer are a growing patient population who have not been previously reported on. Future progress will require trials specific to the elderly, integration of immunotherapy, greater supportive care, better geriatric assessment, and less toxic regimens.

KW - Chemotherapy

KW - Radiation therapy

KW - Resection

KW - Surgery

KW - Treatment

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