Impact of comorbidities on clinical outcomes in non-small cell lung cancer patients who are elderly and/or have poor performance status

Aim: We evaluated the effect of comorbidities on clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) who have poor performance status (PS 2/3) and/or are elderly (>= 70 years old). Summarized description: The impact of age (<70 versus >70), PS, and comorbidity score - Cumulative Illness Rating Scale for Geriatrics (CIRS-G) on treatment response, toxicities, QOL and overall survival (OS) was analyzed using data from a completed phase 11 trial that randomly assigned patients with advanced NSCLC who had PS 2/3 and/or were aged >= 70 to receive gemcitabine (GEM), vinorelbine (VIN) or docetaxel (DOC). Results: Data from records of 134 patients accrued during the trial were available for analysis. Eighty-eight patients (66%) were aged >= 70 years. 59 patients (67%) had PS of ECOG 0-2 and 29 patients (33%) had ECOG 3. In those aged >= 70, 53 (60%) had at least one comorbidity rated CIRS-G category 3/4 while those aged <70, 12 (26%) had at least one CIRS-G 3/4 comorbidity. Age, PS, and comorbidity scores had no significant association with PFS and QOL scores changes, although PS had marginal influence on OS (0.05 < p <0.10). There was significantly greater hematological toxicities and fatigue in patients who had comorbidities of a severe nature. The presence of comorbidity rated CIRS-G category 4 was significantly associated with lower dose intensity of drugs received with no overall impact on response nor survival. In the multivariate analysis, only older patients retained significance with favorable hazard ratio (HR) of 0.5 for overall survival. Conclusions: Presence of comorbidities alone should not deter the oncologist from treating elderly cancer patients with cytotoxics. Patients with severe comorbidities may experience more toxicity and receive less cycles of chemotherapy and early medical intervention to control these comorbidities may mitigate risk of treatment using cytotoxics. (C) 2009 Elsevier Ireland Ltd. All rights reserved.