Abstract 3855: Adjuvant chemotherapy in the elderly with non-small cell lung cancer
Authors: Lee Mijung , Wang Dongliang , Pinto Ian G. , Graziano Stephen , Gajra Ajeet 
Published: May 2015

Introduction: Clinical trials have shown improved survival with adjuvant chemotherapy (AC) for resected stages I-III non-small cell lung cancer (NSCLC). However, data regarding its use in older patients are limited. The objectives of this retrospective analysis were: (i) to assess the change in the frequency of AC use over the period 2000-2010, in both elderly and younger patients; (ii) to study the corresponding survival outcomes in each age group; and (iii) to identify the reasons for not receiving AC among patients in whom AC is recommended based on the current NCCN guidelines.

Methods: After IRB approval, data were collected from the cancer registry at the Syracuse VA Medical Center for retrospective analysis of patients who were diagnosed with NSCLC and underwent surgical resection from 2000 to 2010. Patients were divided based on age groups into younger patients, aged &lt;65 years or the elderly, aged &gt; 65 years. Patients were also divided based on the period of diagnosis: a) 2000 - 2004 and b) 2005 -2010. Pearson Chi-square tests were used to examine patterns of AC use based on age groups and the period of diagnosis. The Kaplan-Meier procedure was used to estimate the survival probabilities. Log rank tests were used to test the equality of survival distributions between groups. Wald tests were used to test the equality of survival probabilities at 5 years, with the standard error estimated by Greenwood's formula. Reasons for non-receipt of AC when indicated but not administered were collected from the medical record.

Results: We identified 154 patients from the tumor registry and 148 patients were included in data analysis after excluding 6 patients who died within 30 days of surgery. Of the 148 patients, AC was indicated in 66 patients but administered in 34 (52%) patients. Of 66 patients 32 (48%) were elderly. There was no difference in baseline characteristics (gender, histology and stage) between the two age groups. AC use was less frequent in the elderly patients (38% vs. 65%, p=0.03). The 5-year survival rate with and without AC was 61% vs. 38% (p=0.23) in elderly and 76% vs. 25% (p=0.001) in younger patients.

For all 66 patients combined, there was a trend for more frequent use of AC after 2005, (41% vs. 63%, p=0.08). The proportion of elderly patients receiving AC prior to 2005 increased from 25% to 58% after 2005 (p=0.06). Cisplatin compared with carboplatin was used infrequently in the elderly (8% vs. 32%, p=0.210). Elderly patients were more likely to not receive AC even when indicated due to patient refusal or the oncology provider not offering AC (38% vs. 12%, p=0.015)

Conclusion: Elderly patients with resected NSCLC are treated with AC less often than younger patients. There is a trend towards increased utilization of AC since 2005. The rate of refusing or not being offered AC was higher among elderly patients as compared to younger patients. Provider and patient education may enhance utilization of AC in NSCLC to improve outcomes in the elderly.

Citation Format: Mijung Lee, Dongliang Wang, Ian G. Pinto, Stephen Graziano, Ajeet Gajra. Adjuvant chemotherapy in the elderly with non-small cell lung cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3855. doi:10.1158/1538-7445.AM2014-3855