MedifocusHealth

Individuals 70 years of age or older represent about 25% of all patients with small cell lung cancer (SCLC). In the past, doctors were often reluctant to administer chemotherapy to elderly patients with small cell lung cancer because of concerns of adverse side-effects and other underlying serious medical conditions (co-morbidity). Currently, many oncologists believe that age per se is not an absolute contraindication to chemotherapy and that treatment decisions should be guided by the patient's overall health and performance status.

One of the tests that is often used to evaluate a patient's performance status is known as the Karnofsky Performance Status scale. This test measures the extent of a cancer patient's functional impairment on the basis of their ability to:

• Perform normal activities of daily living
• Work (employment) capacity
• Degree of self-reliance - how well the patient can function independently without assistance from others

The Karnofsky Performance Status scores range from 0 to 100. The higher the score, the less the degree of functional impairment. In general, patients with good performance status have a better prognosis than those with poor performance status.

Currently, it is recommended that elderly patients with extensive-stage SCLC who have good performance status and normal organ function should be treated with platinum-based chemotherapy with thoracic radiation therapy if indicated. Therefore, as is the case for younger patients, combination chemotherapy with cisplatin (or carboplatin) plus etoposide is the mainstay of treatment for elderly patients with extensive-stage SCLC who have good performance status and no serious comorbid conditions.

Treatment options for elderly patients with poor performance status or those with compromised organ function due to other comorbid conditions include:

• Oral etoposide for 14 days combined with carboplatin on day 1 every 28 days for 4-6 cycles.
• Abbreviated chemotherapy with cyclosphosphamide, doxorubicin, and vincristine (CAV) in full doses followed 3 weeks later with cisplatin/etoposide.
• Combination chemotherapy with carboplatin plus gemcitabine.