Article Text

Download PDFPDF
Palliative immunotherapy in the frail elderly: non-small cell lung cancer
  1. Teodora Stratulat Alexa1,
  2. Ioana Alexa2 and
  3. Sabina Antoniu3
  1. 1 Medicine III-Oncology, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi, Romania
  2. 2 Medicine II-Geriatrics, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi, Romania
  3. 3 Medicine II-Nursing/Palliative Care, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi, Romania
  1. Correspondence to Dr Sabina Antoniu, Medicine II-Nursing/Palliative Care, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi 700115, Romania; sabina.antoniu{at}outlook.com

Statistics from Altmetric.com

Introduction

In oncology clinical trials, elderly are often under-represented and this status quo still persists despite a clear need for efficacy data in this age category.1 This is due to several reasons: first, the survival age in the general population is increasing and so is the pool of subjects belonging to the older age. Second, many prevalent malignancies such as lung cancer are most often cancers of the elderly. Last but not least, the efficacy data for oncological therapies in the elderly might help a lot in better tailoring their management approach.

Among the causes related to the clinical study design, often exclusion criteria are represented by the presence of various comorbid chronic conditions and by poor performance (functional) status that are both attributes of ageing. However, can physical frailty be a major reason for avoiding cancer drugs in elderly? This perspective tries to make the case for the use of immune therapy in elderly with impaired functional status based on the available (even if limited) evidence and based on the premise that in such patients this approach can still have the potential to improve the quality of life as a palliative care approach.

Challenges in treating the frail elderly with cancer

Frailty or more specifically primary frailty is an attribute of the ageing and therefore can be considered as a geriatric phenotype. In fact the first definition of frailty was set up based on a number of features (Fried criteria, Box 1)2 which assess physical activity and its risk factors for impairment. Frailty can be diagnosed with the help of these criteria or by using derived scales such as the Clinical Frail Scale (CFS) for example. In a study performed in patients attending an oncology clinic (n=237), the CFS Score was able to predict survival and the probability to be discharged at home: a score …

View Full Text

Footnotes

  • Contributors SA: draft writing, topic proposal, draft structuring and draft revision. TSA: draft writing, draft structuring and draft revision. IA draft writing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.