Although numerous randomized clinical trials have demonstrated a benefit of chemotherapy for patients with small-cell lung cancer (SCLC), these trials have predominantly compared different chemotherapy regimens rather than comparing chemotherapy to best supportive care. Some of them included chest radiation or prophylactic cranial irradiation. Moreover, many trials excluded elderly patients.
A recent retrospective study looked at the benefit of chemotherapy on survival of elderly patients with SCLC in the community. This is the first large-scale analysis of chemotherapy use among patients with SCLC in the community setting.
In the October issue of the International Association for the Study of Lung Cancer's journal, the Journal of Thoracic Oncology (JTO), researchers conclude that chemotherapy is associated with a greater than 6-month improvement in median survival among elderly patients with SCLC, even in patients over the age of 80 years.
The researchers looked at data from 10,428 patients aged 65 years and older who were diagnosed with SCLC between 1992 and 2001. In this study, 67.1 percent received chemotherapy, most of whom (41.6 percent) received etoposide with carboplatin or cisplatin with or without other agents.
The researchers found that one third of elderly patients with SCLC never receive chemotherapy, and one sixth are never referred to a medical oncologist, suggesting that chemotherapy is underused.
They conclude that, "despite methodological limitations, their study provides strong evidence that chemotherapy improves survival in elderly patients with SCLC."