From the Journals

Carboplatin plus pemetrexed should be ‘a standard option’ in elderly patients with NSCLC



Performance status is key

A lung cancer specialist who was not involved in the study agreed with the authors that age should not be the primary determinant for choice of a treatment regimen.

“There’s a convergence of data over the last decade or so that has really clearly shown that our treatment decisions should be based on performance status much more than chronologic age, certainly for our patients who are in their 70s, and even potentially into their early 80s,” Howard (Jack) West, MD, of City of Hope Comprehensive Cancer Center in Duarte, Calif., said in an interview.

“The available data really say that patients with a good performance status who are in their 70s should be treated just like patients in their 60s and 50s,” he said.

He added, however, that for patients such as those in the study without targetable driver mutations, the best treatment would likely be immunotherapy or immunotherapy combined with chemotherapy.

“If there were a patient with a nonsquamous non–small cell lung cancer where we would be thinking about carboplatin and pemetrexed, I would go further than just carbo and pemetrexed; I would give carbo and pemetrexed with pembrolizumab for most of these patients,” he said.

Dr. West said the study primarily offers reassurances about the efficacy and tolerability of the carboplatin/pemetrexed combination in patients aged 75 years and older.

The study was funded by agencies of the Japanese government. The investigators disclosed relationships with Boehringer Ingelheim, AstraZeneca, Eli Lilly Japan KK, and many other companies. Dr. West disclosed consulting for Merck.

SOURCE: Okamoto I et al. JAMA Oncol. 2020 Mar 12. doi: 10.1001/jamaoncol.2019.6828.

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