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Benefits of palliative chemotherapy in patients over the age of 70 with oesophago-gastric cancers
Oesophago-gastric cancer represents a major cause of
cancer-related mortality and morbidity. The role of palliative
chemotherapy in this disease is now well established.
While elderly patients represent a significant proportion of
patients with oesophago-gastric and other cancers, they are frequently
under-represented in clinical trials evaluating the benefits of palliative
chemotherapy thus limiting the generalisabilty of research results. There
is a common perception that elderly patients tolerate palliative
chemotherapy poorly compared to younger patients and this may result in
more conservative treatment strategies for this patient population. This recently published analysis aimed to evaluate the benefits of palliative chemotherapy in patients over the age of 70 with oesophago-gastric cancers. Data were pooled from three large randomised studies of treatments with platinum based chemotherapy, protracted venous 5-FU/mitomycin C or FAMTX (5-FU, methotrexate and doxorubicin). Of the 1080 patients randomised, 257 were 70 years or older. There were no significant differences in overall or severe (grades 3/4) chemotherapy-related toxicity between patients over or under the age of 70 years. Similarly, there were no significant differences in response to therapy or survival benefits between older and younger patients for each of the three palliative chemotherapy regimens. In multivariate analysis, age was not identified as a prognostic factor for overall or failure-free survival whereas good performance status and locally advanced disease were identified as favourable prognostic variables. Therefore, provided that the standard eligibility criteria are met, this analysis suggests that elderly patients should not be excluded from clinical trials of palliative chemotherapy. For patients with oesophago-gastric cancers, age per se should not be used as a determinant of suitability for palliative chemotherapy. Rather co-morbidities and an assessment of physiological status should be the main considerations.
Bibliographical reference:
Naureen Starling Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK
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