Tracey Evans, MD, Associate Professor of Clinical Medicine University of Pennsylvania Health System, discusses how to determine which patients will benefit from chemotherapy.

The elderly, who are defined as those aged 65 or older, have historically not been considered good candidates for chemotherapy, Evans says. Because of this, they are often denied chemotherapy or given more gentle chemotherapy regimen.

Evans says more recent studies have shown that physiologic age is more important than chronological age. While elderly patients tend to experience more toxicities with chemotherapyâ€‹, they see the same survival benefit from platinum-based doublet chemotherapy as non-elderly patients.

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Dr. Tracey Evans on Chemotherapy for the Elderly Patient

Tracey L. Evans, MD, associate professor of clinical medicine, University of Pennsylvania Health System, discusses treatment of poor performance status (PS) and elderly patients with lung cancer.

Because of a bias that elderly patients with lung cancer would not benefit from chemotherapy, they are typically either denied the treatment or administered a single-agent chemotherapy, Evans explains. However, recent data show that physiological age is a more accurate factor for treatment versus chronological age. Therefore, elderly patients can benefit from platinum-based, doublet chemotherapy, which is used in younger patients. Although this treatment does have more toxicity, it has a survival benefit.

Patients with an ECOG PS of 3 or 4 are less likely to benefit and more likely to be harmed from chemotherapy. Patients with an ECOG PS of 2 also are known to have poor responses from chemotherapy. However, in a recent study comparing single-agent pemetrexed versus carboplatin pemetrexed, ECOG PS 2 patients had a significantly improved survival benefit for the doublet combination relative to the single agent.

Evans says though patients with this PS may respond well to the doublet chemotherapy, they may also experience more toxicity than patients with a higher PS.

Tracey L. Evans, MD

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Dr. Tracey Evans on Chemotherapy for the Elderly Patient

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