04.01.2016 1 Lung Cancer in Older Adults….. Appropriate treatment? Dr Christopher Steer Border Medical Oncology Albury-Wodonga Inaugural Chair Geriatric Oncology Interest Group (COSA) Faculty Disclosure Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Ownership/ Equity Position Employee Other (please specify) Janssen X Gilead X Amgen X Travel espenses No, nothing to disclose X Yes, please specify: Lung cancer in a global context Lung Cancer Stats - Australia 2010 Lung Cancer Stats - Australia 2010 AIHW & AACR 2010. Cancer in Australia: an overview, 2010. Cancer series no. 60. Cat. no. CAN 56. Canberra: AIHW. Lung Cancer Stats - Singapore Lung Cancer Stats - Singapore http://www.nccs.com.sg/patientcare/whatiscancer/cancerStatistics/Pages/Home.aspx What is the definition of Elderly? Depends on your point of view.....
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Cancer in Older Adults….. - International Society of Geriatric … · 04.01.2016 3 Cancer in the Older Person Individualised management? + Individualised Oncologic and Geriatric
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04.01.2016
1
Lung Cancer in Older Adults…..
Appropriate treatment?
Dr Christopher SteerBorder Medical Oncology
Albury-WodongaInaugural Chair Geriatric Oncology Interest Group (COSA)
Faculty Disclosure
Company NameHonoraria/Expenses
Consulting/ Advisory Board
Funded Research
Royalties/ Patent
Stock Options
Ownership/ Equity
PositionEmployee
Other (please specify)
Janssen X
Gilead X
Amgen X Travel espenses
No, nothing to disclose X Yes, please specify:
Lung cancer in a global context Lung Cancer Stats - Australia 2010Lung Cancer Stats - Australia 2010
AIHW & AACR 2010. Cancer in Australia: an overview, 2010. Cancer series no. 60. Cat. no. CAN 56. Canberra: AIHW.
Lung Cancer Stats - SingaporeLung Cancer Stats - Singapore
In solid tumour trials – Elderly = Age > 70 years.In solid tumour trials – Elderly = Age > 70 years.
ELVIS trial – something vs nothing.ELVIS trial – something vs nothing.
Generally accepted in solid tumours “elderly” = >70 yearsGenerally accepted in solid tumours “elderly” = >70 years
Elvis Trial – something vs nothing.Elvis Trial – something vs nothing. Chemotherapy – The Blunderbuss approachChemotherapy – The Blunderbuss approach
The word Blunderbuss is of Dutch origin, from the Dutch word donderbus, which is a combination of donder, meaning "thunder", and bus, meaning "Pipe" (Middle Dutch: busse, box, tube, from the late latin buxis meaning “box”) from Ancient Greek pyxίs (πυξίς), box: esp. from boxwood.
Chemotherapy – The Blunderbuss approachChemotherapy – The Blunderbuss approach Cancer in the Older Adult – Lung CancerCancer in the Older Adult – Lung Cancer
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Cancer in the Older Person
Individualised managementCancer in the Older Person
Individualised management
?
+
Individualised Oncologic and Geriatric Care Plan
Targeted therapy
EGFR mutation status in Asian patientsEGFR mutation status in Asian patients Cancer in the Older Adult – Lung CancerCancer in the Older Adult – Lung Cancer
EGFR mutation status in Asian patientsEGFR mutation status in Asian patients EGFR mutation status in Asian patientsEGFR mutation status in Asian patients
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Individual EGFR mutations in Asian patients
Individual EGFR mutations in Asian patients
Cancer in the Older Person
Individualised managementCancer in the Older Person
Immunotherapy – the “long tail” effect…Immunotherapy – the “long tail” effect…
Clin Cancer Res January 15, 2012 18; 336
Examples of PD-L1 NSCLC Sample Immunohistochemical Staininga
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
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Response Rate by RECIST v1.1 (Central Review) and by irRC (Investigator-Assessed) with PD-L1 Clinical Trial Assaya
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Maximum Percent Change from Baseline in Tumor Size in Evaluable Patientsa (Central Review, RECIST v1.1)
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Maximum Percent Change from Baseline in Tumor Size in Evaluable Patientsa (Central Review, RECIST v1.1)
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Antitumor Activity by Pembrolizumab Dose
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Time to and Durability of Responsea
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Change From Baseline in Tumor Size in All Evaluable Patientsa (RECIST v1.1 by Central Review)
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
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Change From Baseline in Tumor Size in All Evaluable Patientsa (RECIST v1.1 by Central Review)
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Change From Baseline in Tumor Size in Patients With New Lesions (RECIST v1.1 by Central Review)
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Conclusions
Presented By Naiyer Rizvi at 2014 ASCO Annual Meeting
Conclusions - Let’s put it all together……Conclusions - Let’s put it all together……
1. Aim for appropriate treatment
2. Can be achieved via adequate assessment and avoidance of ageism.
3. There is developing evidence that older patients can benefit from standard treatments and that undertreatment is detrimental.
1. Aim for appropriate treatment
2. Can be achieved via adequate assessment and avoidance of ageism.
3. There is developing evidence that older patients can benefit from standard treatments and that undertreatment is detrimental.
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Conclusions…..2Conclusions…..2
Practical aspects of treating older patients with lung cancer.
1. Doublet chemotherapy should be the standard of care in older patients with lung cancer. Single agent chemotherapy should be reserved for patients considered unfit for platinum agents and/or of poor performance status (regardless of age).
2. The role of a formal geriatric assessment and the CARG tool for treatment decisions as well as an intervention should be explored further.
Practical aspects of treating older patients with lung cancer.
1. Doublet chemotherapy should be the standard of care in older patients with lung cancer. Single agent chemotherapy should be reserved for patients considered unfit for platinum agents and/or of poor performance status (regardless of age).
2. The role of a formal geriatric assessment and the CARG tool for treatment decisions as well as an intervention should be explored further.
Conclusions…..3Conclusions…..3
Practical aspects of treating older patients with lung cancer.
1. Bevacizumab is not routinely recommended for older patients due to lack of efficacy and increased toxicity.
2. Targeted therapies such as EGFR and ALK inhibitors should be used in patients who exhibit the target regardless of age.• but watch out for increased toxicities
Practical aspects of treating older patients with lung cancer.
1. Bevacizumab is not routinely recommended for older patients due to lack of efficacy and increased toxicity.
2. Targeted therapies such as EGFR and ALK inhibitors should be used in patients who exhibit the target regardless of age.• but watch out for increased toxicities