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ECCO 2017 webcasts - Part 4

"The right time, the right sequence" by Nicholas Thatcher

Nicholas Thatcher
Christie Hospital NHS Trust
Manchester UK

Dr Thatcher introduces a case study of a 76-year old male, a heavy smoker, who presents with a persistent cough and weight loss. A CT scan reveals a left lung mass and liver metastasis. The diagnosis is squamous non-small cell lung cancer (SQ-NSCLC), Stage IV. There are a number of options to use as first-line treatment for this patient, the standard is platinum-based chemotherapy with gemcitabine (GEM-CIS), as the addition of gemcitabine showed a 4% overall survival benefit in a meta-analysis.

In the SQUIRE trial, which compared GEM-CIS to GEM-CIS + necitumumab showed a 6-week increase in overall survival (OS). Although this may not be considered clinically significant to a physician, it may be significant to the patient. 

Currently, an elderly patient is often defined as being over 70 years of age, and caution in treating these patients is exercised due to functional age, comorbidities and an increased risk of toxicity from therapy. Dr Thatcher presents some data on chemotherapy in elderly patients where a survival benefit of 4 months was observed in patients aged between 70-89 years when given doublet therapy (paclitaxel-carboplatin) compared to gemcitabine or vinorelbine given as single agents. In light of these results, he suggests that perhaps we need to reconsider the definition of elderly and the constraints of treatment given in various guidelines.

The case-study patient completed 4 cycles of gemcitabine-carboplatin and achieved stable disease. Four months later progression was observed. Dr Thatcher discusses further treatment options for this patient. He reviews docetaxel or erlotinib as the two agents with existing data for treating post-platinum therapy. To wrap up, Dr Thatcher presents a treatment algorithm for 2017 that helps to guide clinicians in treating lung cancers in all patients.