Meeting Highlight

Lung cancer in the elderly

To evaluate the safety and survival outcomes of computed tomography–guided microwave ablation (MWA) for medically inoperable Stage I non–small cell lung cancer (NSCLC) in patients aged ≥70 years.

This study was a prospective, single-arm, single-center clinical trial. The MWA clinical trial enrolled patients aged ≥70 years with medically inoperable Stage I NSCLC from January 2021 to October 2021. All patients received biopsy and MWA synchronously with the coaxial technique. The primary endpoints were 1-year overall survival (OS) and progression-free survival (PFS). The secondary endpoint was adverse events.

A total of 103 patients were enrolled. Ninety-seven patients were eligible and analyzed. The median age was 75 years (range, 70–91 years). The median diameter of tumors was 16 mm (range, 6–33 mm). Adenocarcinoma (87.6%) was the most common histologic finding. With a median follow-up of 16.0 months, the 1-year OS and PFS rates were 99.0% and 93.7%, respectively. There were no procedure-related deaths in any patient within 30 days after MWA. Most of the adverse events were minor.

MWA is an effective and safe treatment for patients aged ≥70 years with medically inoperable Stage I NSCLC.

To describe outcomes and compare the effectiveness of stereotactic body radiotherapy (SBRT) versus 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) in patients with stage IIA lymph node-negative (N0) non-small cell lung cancer (NSCLC) tumors > 5 cm.

We used the SEER-Medicare database (2005-2015) to identify patients > 65 years with stage IIA (AJCC TNM7) N0 NSCLC > 5 cm tumors who were treated with SBRT, IMRT, and 3DCRT. We used propensity score methods with inverse probability weighting to compare lung cancer-specific survival (LCSS), overall survival (OS), and toxicity.

Of 584 patients, 88 (15%), 140 (24%), and 356 (61%) underwent SBRT, IMRT, and 3DCRT, respectively. The SBRT group was older (P = .004), had more comorbidities (P = .02), smaller tumors (P = .03), and more adenocarcinomas (P < .0001). We found a trend towards higher median unadjusted OS with SBRT compared to IMRT and 3DCRT (19 vs. 13 and 14 months, respectively, P = .37). In our propensity score-adjusted analyses, SBRT was significantly associated with better OS and LCSS compared to IMRT (HR_OS: 0.78, 95% CI: 0.68-0.89, HR_LCSS: 0.70, 95% CI: 0.60-0.81) and 3DCRT (HR_OS: 0.81, 95% CI: 0.72-0.93, HR_LCSS: 0.80, 95% CI: 0.68-0.93). SBRT-treated patients also had lower overall adjusted complication rates compared to IMRT (OR: 0.74, 95% CI: 0.55-0.99) and 3DCRT (OR: 0.53, 95% CI: 0.40-0.71).

For patients with NSCLC tumors > 5 cm, SBRT trends towards fewer toxicities and improved survival compared to other forms of radiotherapy. Our findings support SBRT as an appropriate treatment strategy for older patients with larger inoperable NSCLC tumors.

Surgery is the recommended treatment modality for patients with non-small cell lung cancer (NSCLC) stage I-II. Meta-analyses of randomized studies demonstrates a survival benefit with adjuvant chemotherapy—including neo-adjuvant chemotherapy—for stage IB-IIIA patients, resulting in a reduced hazard ratio (HR) to 0.83–0.92, with absolute benefits of 5.4% to 6.9% at five years. Comparable level of risk reduction has been shown with neoadjuvant chemotherapy but with less robust evidence. Currently any of the available studies that investigated the role of personalized chemotherapy based on individual gene expression have generated disappointing results. The role of targeted therapies in this setting remains undefined. A large randomized trial (ECOG 1505) demonstrated no benefit to using adjuvant bevacizumab in unselected early stage patients. Results from a large prospective placebo-controlled study showed no benefit from the use of adjuvant epidermal growth factor (EGFR) tyrosine kinase inhibitor erlotinibs (TKIs), but the study was not designed specifically for patients with tumors harboring EGFR mutations. In addition, other studies have demonstrated no effect of EGFR TKIs as adjuvant therapy in unselected patients. Ongoing large prospective studies are evaluating the role of EGFR TKIs in the EGFR-mutant population, ALK-inhibitors in the ALK+ population, and immunotherapy in the non-biomarker-selected population.

Non-small-cell lung cancer (NSCLC) is one of the most common cancers and the leading cause of cancer-related deaths. In East Asia, traditional herbal medicine (THM) is commonly used in clinical settings for the treatment of cancer. Therefore, the aim of the present review was to systematically assess the efficacy of THM with varied components for the treatment of NSCLC.

This study identified randomized controlled trials (RCTs) that evaluated the effectiveness of combined THM and chemotherapy (CTx) in searches of English, Chinese, Japanese, and Korean language databases.

This meta-analysis systematically reviewed 27 RCTs involving 2382 patients and found that THM improved the quality of life (QoL) significantly for patients with NSCLC. Improvement in QoL was seen in 19 studies using the Karnofsky Performance Status score, three studies using the Eastern Cooperative Oncology Group scale, three studies using the Functional Assessment of Cancer Therapy-Lung scale, and six studies using the European Organization for Research and Treatment of Cancer.

The pooled results of this systematic review and meta-analysis suggest that THM significantly improved the QoL for patients with NSCLC.

Elderly patients with advanced non-small cell lung cancer (NSCLC) are thought to receive suboptimal treatment mainly due to concerns for poor compliance and/or excessive toxicity.

Using the age of 70 years as the pre-defined cut-off, we compared elderly patients with advanced NSCLC suitable for first line chemotherapy with their younger counterparts in terms of: i) diagnosis and disease characteristics ii) adherence to treatment schedule, including dose intensity (DI), and relative dose intensity (RDI), iii) toxicity, tolerance, and efficacy outcomes.

Among 292 eligible patients, data were available for 245, of whom 107 (43.7%) belonged to the elderly group. This group was more likely to present with co-morbidities, non-smoking current status and diagnosis based on cytology alone. As compared to the non-elderly, elderly patients were more likely to receive single-agent therapy (8.0% vs. 29.2% respectively, p < 0.001) and less likely to receive platinum-based chemotherapy (80.3% vs. 57.9%, p < 0.001). Elderly patients also received docetaxel (24.3% vs. 40.4%), and bevacizumab (7.5% vs. 21.3%) significantly less often and received oral vinorelbine (24.3% vs. 11.8%) more frequently. Non-elderly patients were more likely to receive any of the cytotoxic drugs with RDI > 0.8 (49.6% vs. 33.0%, p = 0.012) and RDI > 0.9 (29.6% vs. 16%, p = 0.015). Substantial toxicity, as well as median overall survival did not differ significantly between the two groups.

Only one third of the elderly patients received at least 80% of the scheduled treatment intensity. Nearly half received diagnosis based on cytology alone, which may deprive them from new, histology-driven, therapeutic approaches.