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Advanced NSCLC in the Frail/Elderly: Podcast of Discussion with Drs. Hesketh and Kelly
The last of our three cases reviewing management issues in elderly and frail patients with lung cancer, as covered in a recent webinar discussion I had with experts Paul J. Hesketh from Lahey Clinic and Karen Kelly from Kansas University Medical Center, focuses on treatment of advanced/metastatic NSCLC. Drs. Hesketh and Kelly are two of the world experts in this field that so desperately needs more research and careful thought, given that the median age of patients newly diagnosed with lung cancer in the US is now just over 70, and about a third of patients are frail, but our studies primarily or exclusively include younger, healthy patients. In fact, the figures include the reference of a review article that Dr. Hesketh is just publishing now in the Journal of Thoracic Oncology on treating patients 80 and older with lung cancer (it appears online but hasn’t appeared in the actual printed journal yet).
Here is the audio and video versions of the podcast, along with the figures and transcript.
adv-nsclc-in-frail-and-elderly-patients-hesketh-and-kelly-audio-podcast
adv-nsclc-in-frail-and-elderly-patients-hesketh-and-kelly-transcript
adv-nsclc-in-frail-and-elderly-patients-hesketh-and-kelly-figs
As always, we welcome your thoughts and comments.
This program was made possible by an educational grant from OSI Pharmaceuticals, who had no input in its content. We thank them for their support.
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3 Responses to Advanced NSCLC in the Frail/Elderly: Podcast of Discussion with Drs. Hesketh and Kelly
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I am getting even more confused now, having listened to Dr Hesketh’s comments. Have you had any success with Tarceva in patients who tested negative for the EGFR mutation.
My diagnosis is ‘Adenocarcinoma with mucinous broncho-alveolar features’ Stage IV (F 46yrs ex-smoker)(took the best part of a year to diagnose as the possibilities considered where – pneumonia; invasive aspergillosis; tuberculosis; wegener’s). Had 2 rounds of treatment with Gemcitabine and Carboplatin at the end of last year but refused anymore. My consultant says if my condition deteriorates I can have Tarceva. Most things I have read seem to imply that this isn’t worth doing.
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Thank you.
Kat
It is far more accurate to say that the clear majority of patients who have a dramatic, prolonged response to Tarceva (erlotinib) or Iressa (gefitinib) have an EGFR mutation (though NOT all), but that the patients who don’t have an EGFR mutation still overall receive a benefit that tends to be more modest. In fact, on the pivotal trial known as BR.21 that compared Tarceva to placebo in chemo pre-treated patients with advanced NSCLC, even the subset of patients who were men with squamous tumors and a smoking history (the opposite of the patient “type” you’d expect to benefit from an EGFR inhibitor, and a group with a mutation rate less an 1%) had an improvement in median survival by 2.1 months (vs. 2.0 months in the overall population on the trial) despite almost no official “responses”. Instead, the survival benefit was presumably based on prolonged minor tumor shrinkage/stable disease, which is clearly better than disease progression.
You can read more in the subject archives, particularly at some posts in the folder on targeted therapies in the “core concepts” section of the lung cancer topic area. But the basic idea is that while the patients with an EGFR mutation are the ones who tend to have the best results with an oral EGFR inhibitor, patients who don’t have an EGFR mutation can still benefit and often do, albeit generally more modestly.