Adding cisplatin to docetaxel monotherapy provides no benefit for elderly with NSCLC

What lesson can we learn from this study, and how should the results influence current management of elderly patients with lung cancer?

It is important to accurately interpret the finding of this study, which is that the combination of cisplatin/docetaxel administered on a weekly schedule is not superior to single-agent docetaxel given every 3 weeks in patients older than 70 years of age with lung cancer. The study does not negate the well-founded recognition that patient age does not preclude clinical benefit of systemic anticancer therapy and that elderly patients with lung cancer should be offered systemic therapy if they are fit enough to tolerate the treatment.

Although the study was designed to evaluate treatment efficacy in elderly patients, only patients who were unsuitable for bolus cisplatin infusion were included. As there is no clear definition for patients unsuitable for bolus cisplatin, we believe that this might have led to the enrollment of a patient subset with unfavorable prognosis. The interpretation, external validity, and generalizability of the result of this study are greatly limited because the unwieldy definition of patients considered unsuitable for cisplatin makes it difficult to establish how well the study population represents the elderly patient population with lung cancer.

There is increasing agreement that treatment decisions for elderly patients should be based on performance status, comorbid conditions, and patient preferences. Treatment decisions based entirely on chronological age and not informed by the tremendous knowledge gained in optimal assessment of older patients in recent years do not serve our patients well. Finally, it is imperative to include functional assessment as an integral component of clinical trials designed for older patients.

Dr. Taofeek K. Owonikoko and Dr. Suresh S. Ramalingam are with Emory University and Winship Cancer Institute, Atlanta. These remarks were extracted from the accompanying editorial (J. Clin. Onc. 2015 Jan. 12 [doi:10.1200/JCO.2014.59.5033]).