GRACE :: Lung Cancer
Denise Brock

Lung Cancer Video Library – Spanish Language: Video #7 What is the best treatment for frail patients with advanced NSCLC?

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For our 7th video in the GRACE Spanish Lung Cancer Library, Antonio Calles, MD, Medical Oncologist, Thoracic Oncology Program, Hospital General Universitario, Gregorio Marraron, Madrid, Spain joined GRACE to discuss the best treatment for frail patients with advanced NSCLC.


 

 

 

 


 

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TRANSCRIPTS – Spanish and English
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¿Cuál es el mejor tratamiento para pacientes débiles con cáncer pulmonar de células no pequeñas en estado avanzado?

Desgraciadamente a veces cuando se diagnostica el cancer de pulmón, el paciente tiene mucha sintomatología derivado de ese tumor, esto es lo que nosotros nos referimos como “performance status” (PS) que es la situación clínica del tumor. Los pacientes que tienen un performance status de 3-4, es decir, que pasan la mayor parte de su día en la cama y no son capaces de autocuidado, se les aconseja el uso de tratamiento y es muy encarecido que reciban terapia paliativa de soporte, no necesariamente de hospicio, puede ser de manera ambulatoria.

Para los pacientes con mejor situación funcional de 0 a 1 están claras las recomendaciones.

La gran duda son los pacientes con un performance status de 2. En primer lugar, porque la definición de un performance status de 2 es ambigua y es difícil definir esta población. Hay PS 2 que realmente son PS 3 y hay PS 2 que realmente son PS 1. Por lo tanto, en la interpretación de los ensayos clínicos, hay que ser cauto porque no sabemos muy bien qué hacer con estos pacientes. En general, la decisión tiene que ser individualizada y tienen que tener gran peso las expectativas del paciente y de su familia. No podemos recomendar de manera sistemática el uso de quimioterapia o de cualquier otro tipo de quimioterapia a los pacientes con PS2 ya que en algunos pacientes el uso de quimioterapia se asocia a mayor toxicidad y en otra mejora la calidad de vida.

Normalmente se suele preferir los esquemas de monoterapia (un solo fármaco) sobre las combinaciones de platino por el riesgo de mayor toxicidad. Recientemente ha habido un estudio en el que comparaba la administración de carboplatino y pemetrexed sobre pemetrexed solo, demostrando un beneficio en supervivencia y control de la enfermedad con la combinación de carboplatino y pemetrexed. La decisión de tratar o no a un paciente con PS2 debe ser individualizada, no hay recomendaciones generales y se deben de basar fundamentalmente en las expectativas del paciente, la familia y las recomendaciones del médico oncólogo. En cualquier caso, todos estos pacientes deben recibir de una manera precoz un tratamiento paliativo de soporte.


 

Which is the best treatment for weak patients with non-small cell lung cancer in advanced stage?

Unfortunately, sometimes lung cancer is diagnosed in patients with many symptoms from the tumor; this is what we call performance status (PS) which is the clinical situation of the tumor. Patients with a performance status of 3-4, spend most of their day in bed and cannot take care of themselves. They are advised to have a treatment and palliative support therapy, not necessarily from a hospice, it could also be at home.

For patients with a performance status of 0-1 the recommendations are clear.

The big doubt is in patients with a performance status of 2. First of all, because the definition of PS 2 is not clear and it’s harder to define the specific population. There are PS 2 that are truly PS3 and there are also P2 that are PS1. In the interpretation of clinical trials, one has to be careful because we don’t know what to do with these patients. In general, the decision has to be individualized and the most important part are the expectations from the patient and family. We cannot recommend systematically the use of chemotherapy or any other treatment because the result is unknown, so in some patients it can cause toxicity but in others it could improve the quality of life.

 Usually the monotherapies are preferred over combinations with platinum because of the possible toxicity risk. Recently there has been a study where they compared carboplatin and pemetrexed over pemetrexed alone. The result showed an improved in survival and control of the disease using carboplatin and pemetrexed. The decision to treat or not a patient with PS2 is personalized, there are no general recommendations and it the decision has to be based on the patient’s expectative, the family and the oncologist. In any case, all these patients have to receive an early palliative support treatment.


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