ELCC 2014 News: Efficacy and Safety of Targeted Therapy in Elderly Patients With Lung Cancer Adenocarcinoma

Clinical records of elderly patients with non-small-cell lung cancer (NSCLC) show that treatment with bevacizumab seems to be safe and effective in patients with controlled pre-existing cardiovascular disease and good performance status. Furthermore, another targeted agent, erlotinib, represents a valuable treatment option in elderly NSCLC patients with co-morbidities, especially if they harbour EGFR mutations. The data were presented by Prof. Kostas Syrigos on behalf of colleagues from the Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece in a general poster session at the 4th European Lung Cancer Conference (26-29 March 2014, Geneva, Switzerland).

Bevacizumab is a antiangiogenic agent used in many advanced solid tumours, including non-squamous NSCLC. In contrast to clinical studies where enrolled patients are fit, many elderly NSCLC patients suffer from co-morbidities and often have history of a cardiovascular disease, thus preventing them from enrolling in clinical trials. Besides chemotherapy, erlotinib represents a treatment option in NSCLC patients, especially in those with EGFR mutations. However, elderly patients enrolled in trials are fit and without co-morbidities, but in a real clinical practice most of them suffer from co-morbidities. Therefore, the authors retrieved data from medical records in their clinic, since the drug’s availability.

Bevacizumab in elderly patients with NSCLC

Medical records of 2672 patients diagnosed with NSCLC between 2001 and 2012 were screened. The investigators identified patients ≥75 years old treated with bevacizumab and studied their demographical, clinical data and treatment details. They focused on those elderly patients with stable pre-existing cardiovascular disease.

From screened NSCLC patients, 356 received bevacizumab at any treatment line. However, only 33 patients were ≥75 years old. Of those, 29 had various co-morbidities including 19 patients with cardiovascular disease stable under medical treatment. In a group of 19 patients with cardiovascular disease, there were 17 men and two women. The mean age was 77 years (range: 75-86). Eight patients had impaired renal function. However, all patients had good performance status (ECOG 0/1).

The median number of administered bevacizumab cycles was five (range: two-11). The majority of patients (17 of 19) experienced ≥1 side effects: 11 epistaxis and haemoptysis, five proteinuria, and four hypertension. These side effects led to treatment discontinuation in five patients. However, no major/fatal adverse events were noted.

In eight of 19 patients (42%) radiological partial response was recorded and five (19%) experienced disease stabilisation. In total, the responses observed make a total disease control rate of 61%. Median survival from initiation of bevacizumab until death and/or last follow-up was seven months (range: two-28).

Erlotinib in elderly patients with NSCLC

The researchers screened medical records of 1221 NSCLC patients diagnosed with NSCLC between 2008 and 2012 in search for patients ≥75 years and their demographics, clinical data and treatment details. From screened patients, 233 received erlotinib at any line of treatment. However, 53 (23%) were ≥75 years old. From those patients, 34 were men and 19 women. The median age was 79 years (range: 75-88).

Regarding NSCLC subtyping, 31 patients had adenocarcinoma, eight, squamous cell carcinoma, nine, non-squamous cell carcinoma, and five other types. The majority of patients (50 of 53) had co-morbidities, mainly multiple comorbid conditions (≥two in 46 patients, one in four patients). Main co-morbidities were cardiovascular disease in 41 cases, COPD in 14 cases, other cancer in 10 cases and diabetes in eight cases.

Only eight patients were tested for EGFR mutations: five were negative and three positive. Performance status was satisfactory (ECOG 0-1) in a minority of patients (only eight) and poor (ECOG 2-3) in 45 patients.

Eight patients were treated with erlotinib at 100 mg dose and 45 patients with erlotinib 150 mg, but 12 patients needed dose reduction. Complete follow-up data were found in the medical records of 46 patients. Mean duration of treatment was 79 days (range: nine-662).

Most of the patients (35 of 46) experienced side effects (29 rash and 17 diarrhoea) which led to treatment discontinuation in 12 patients. Patients with abnormal creatinine clearance, 13 in total, were more likely to discontinue treatment due to side effects.

Disease control was achieved in 17 of 46 patients (37%) with five partial responses (PR) and 12 stable diseases (SD). A time to progression (TTP) was 157 days (range 106-662), while 22 of 46 patients had progressive disease (PD) as a best response - in those patients TTP was only 49 days (range 19-88). Seven patients were not evaluable as treatment was stopped due to side effects.

All patients with EGFR-positive disease achieved disease control (2 PR, 1 SD).

Targeted therapies should be offered to elderly NSCLC patients

These data show that both drugs are safe and effective in elderly NSCLC patients. These patients might benefit from participation in clinical trials similarly to younger NSCLC patients. In case of erlotinib, they should not be omitted from molecular testing. Erlotinib is a valuable option in elderly NSCLC patients with co-morbidities, especially if they harbour EGFR mutations. However, impaired renal function might be associated with side effects and early treatment discontinuation. Treatment with bevacizumab seems to be safe and effective in elderly NSCLC patients with controlled pre-existing cardiovascular disease and good performance status.

References:

Abstract 106P: Efficacy and Safety of Bevacizumab in Elderly Patients with Lung Cancer Adenocarcinoma

Abstract 107P: Efficacy and Safety of Erlotinib in Elderly Patients with Lung Cancer Adenocarcinoma