Posted by Keith Galloway on Tue, Dec 08, 2009 @ 04:05 PM
To maximize cancer treatment outcomes, oncologists administer what they believe to be the most effective chemotherapy dose tolerated by patients. Yet
research has shown that practitioners may be under-estimating the level of drug patients actually needs to achieve a positive response and improved survival rates.
New research reported in the October 2009 issue of Lung Cancer illustrates this point. Researchers at the S. Paolo Hospital in Milan, Italy studied more than 100 elderly patients diagnosed with advanced non-small cell lung cancer. Dr. A. Luciani and study co-authors compared the relative dose intensity (RDI) of chemotherapy agents administered to NSCLC patients. According to the study abstract, about one-third of patients received RDIs that were suboptimal, or less than 80 percent of the planned dose. The rest received RDIs above 80 percent. The response rate for patients receiving the higher doses was 55.2 percent compared to 33.3 percent for patients on the suboptimal doses.
Among the study authors' conclusions, it's noted that "an adequate dose intensity has a significant positive impact on both response rate and overall survival." With elderly patients oncologists may be too often erring on the side of suboptimal doses, and undertreatment, in order to avoid toxicity. But the research provides evidence that patients aged 70 and older can and should receive the optimal dose.
A second study published in the same journal compared the benefits of chemotherapy for elderly lung cancer patients versus younger patients. Mariano Provencio and associates examined treatment, toxicity, response rate, and survival in patients enrolled in six clinical trials. Their analysis found no significant differences in terms of treatment cycles or response rates. In their conclusions, study authors called for "more selective treatments, based on the genetic differences that older patients have."
Both studies support the principles of personalized medicine, and specifically personalized dose management. In the first study, individual characteristics such as body mass index, were more important than age in determining dose intensity. Even though the patients were older, the optimal dose brought about improvements both in terms of response and overall survival.
Given the fact that the number of elderly patients with cancer is on the rise, personalized chemotherapy management-with the goal of achieving optimal dosing and outcomes-merits further consideration. By incorporating optimal dose management into routine practice, oncologists can achieve greater efficacy with both elderly and young patients.