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Ageism and cancer treatment: fallacy not fact
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Abiraterone significantly prolongs radiographic progression-free survival in patients with metastatic castration-resistant prostate cancer who have not previously had chemotherapy, according to the results of a randomised phase 3 study in 1088 patients. US regulators have accordingly licensed abiraterone—an androgen biosynthesis inhibitor—for use in this population of patients (it is already approved for postchemotherapy use) and a similar amendment is expected in Europe. Since at least half of patients with prostrate cancer—a largely elderly cohort—do not receive chemotherapy, this expansion of abiraterone’s license potentially doubles the number of patients who can be given the drug. Median time to radiographic progression was 16·5 months for patients who received abiraterone plus prednisone versus 8·3 months for
those who received prednisone alone. Abiraterone also delayed clinical decline, need for chemotherapy, and onset of pain. The findings prompted the independent data monitoring committee to recommend the study be unblinded and patients from the placebo group be permitted to crossover, which means it will be difficult to conclusively show the “strong trend toward improved survival” that the authors described. “For one of the first times with this disease, we have a treatment option that is designed around preserving function and preserving a good quality of life in delaying progression of cancer”, explains coauthor Charles Ryan (University of California, San Francisco, CA, USA). Nick James (University of Birmingham, Birmingham, UK) agrees. “Abiraterone is non-toxic, probably improves survival, and certainly has a big effect
on radiologic progression-free survival, which is a meaningful endpoint.” Ryan cautioned that a third of patients in the study were unresponsive to abiraterone, while more than half developed resistance. “We need to have further therapies available for these patients”, he told The Lancet Oncology. A novel androgen-receptor blocking drug— enzalutamide—is expected to receive European approval sometime next year. If radium-223, an isotope that targets bone metastases, also gains approval, then two new therapies with different modes of action would be available. “Patients with prostate cancer tend to sequentially respond to treatment”, said James. “I think we’re going to see all these treatments options bolted one on top of the other.”
Mark J Winter/Science Photo Library
Abiraterone and castration-resistant prostate cancer
Published Online December 21, 2012 http://dx.doi.org/10.1016/ S1470-2045(12)70585-5 For the study see N Engl J Med 2012; published online Dec 10. DOI:10.1056/NEJMoa1209096
Talha Khan Burki
A survey into ageism and attitudes towards elderly patients with cancer undertaken by Macmillan Cancer Support, Age UK, and the UK Department of Health generated media reports suggesting that most elderly patients (ie, those older than 65 years) with cancer are not receiving adequate treatment. The online survey included responses from only 155 UK health professionals, so do the results provide the hard evidence for ageism that has been claimed? Riccardo Audisio (University of Liverpool, Liverpool, UK) told The Lancet Oncology that there is scant evidence to show that elderly patients with cancer in the UK are often under-treated because of ageism. “In fact, the UK is probably miles ahead of many other countries in beating the age barrier to cancer treatment due to the efforts of Mike Richards [National Cancer Director, www.thelancet.com/oncology Vol 14 February 2013
Department of Health] and others”, he pointed out. Audisio rejected the idea of deliberate age discrimination but admitted that treating elderly patients with cancer can be complex. “There is little consensus on how elderly patients with cancer should be assessed and treated as this population is excluded from clinical trials that provide evidence of efficacy for cancer therapies”, he noted. Although elderly patients with cancer are generally fitter than older patients with orthopaedic or cardiovascular diseases and respond well to cancer treatments— particularly surgical procedures— aggressive and potentially curative treatments might be poorly tolerated in those who are frail. With no evidence-based guidelines for assessment of elderly patients with cancer and no well-validated cancer management protocols,
rapid and reliable assessment instruments have become essential. Fast screening tests, taking 3–5 min, have been developed, and can separate frail patients who need to be investigated further and discussed with geriatricians from the larger majority (80–85%) who are reasonably fit and do qualify for active treatment. “Health professionals recognise their responsibility to offer the most appropriate therapeutic opportunity to any cancer patient who needs it, regardless of their chronological age. The big challenge is to continue to raise awareness of cancer to prevent elderly patients being diagnosed very late; the less the fear, the earlier the diagnosis, the more effective the treatment, no matter what the age of the patient”, he stressed.
Will & Deni McIntyre/Science Photo Library
Ageism and cancer treatment: fallacy not fact
Published Online January 4, 2013 http://dx.doi.org/10.1016/ S1470-2045(12)70586-7 For more on the survey see http://www.macmillan.org.uk/ Aboutus/News/Latest_News/ AGEISMINNHSSTOPPINGOLDER CANCERPATIENTSGETTINGBEST TREATMENT.aspx For reviews of screening tests for the elderly see Ecancermedicalscience 2012; 6: 243 and Lancet Oncol 2012; 13: e437–44
Kathryn Senior e48
Abiraterone significantly prolongs radiographic progression-free survival in patients with metastatic castration-resistant prostate cancer who have not previously had chemotherapy, according to the results of a randomised phase 3 study in 1088 patients. US regulators have accordingly licensed abiraterone—an androgen biosynthesis inhibitor—for use in this population of patients (it is already approved for postchemotherapy use) and a similar amendment is expected in Europe. Since at least half of patients with prostrate cancer—a largely elderly cohort—do not receive chemotherapy, this expansion of abiraterone’s license potentially doubles the number of patients who can be given the drug. Median time to radiographic progression was 16·5 months for patients who received abiraterone plus prednisone versus 8·3 months for
those who received prednisone alone. Abiraterone also delayed clinical decline, need for chemotherapy, and onset of pain. The findings prompted the independent data monitoring committee to recommend the study be unblinded and patients from the placebo group be permitted to crossover, which means it will be difficult to conclusively show the “strong trend toward improved survival” that the authors described. “For one of the first times with this disease, we have a treatment option that is designed around preserving function and preserving a good quality of life in delaying progression of cancer”, explains coauthor Charles Ryan (University of California, San Francisco, CA, USA). Nick James (University of Birmingham, Birmingham, UK) agrees. “Abiraterone is non-toxic, probably improves survival, and certainly has a big effect
on radiologic progression-free survival, which is a meaningful endpoint.” Ryan cautioned that a third of patients in the study were unresponsive to abiraterone, while more than half developed resistance. “We need to have further therapies available for these patients”, he told The Lancet Oncology. A novel androgen-receptor blocking drug— enzalutamide—is expected to receive European approval sometime next year. If radium-223, an isotope that targets bone metastases, also gains approval, then two new therapies with different modes of action would be available. “Patients with prostate cancer tend to sequentially respond to treatment”, said James. “I think we’re going to see all these treatments options bolted one on top of the other.”
Mark J Winter/Science Photo Library
Abiraterone and castration-resistant prostate cancer
Published Online December 21, 2012 http://dx.doi.org/10.1016/ S1470-2045(12)70585-5 For the study see N Engl J Med 2012; published online Dec 10. DOI:10.1056/NEJMoa1209096
Talha Khan Burki
A survey into ageism and attitudes towards elderly patients with cancer undertaken by Macmillan Cancer Support, Age UK, and the UK Department of Health generated media reports suggesting that most elderly patients (ie, those older than 65 years) with cancer are not receiving adequate treatment. The online survey included responses from only 155 UK health professionals, so do the results provide the hard evidence for ageism that has been claimed? Riccardo Audisio (University of Liverpool, Liverpool, UK) told The Lancet Oncology that there is scant evidence to show that elderly patients with cancer in the UK are often under-treated because of ageism. “In fact, the UK is probably miles ahead of many other countries in beating the age barrier to cancer treatment due to the efforts of Mike Richards [National Cancer Director, www.thelancet.com/oncology Vol 14 February 2013
Department of Health] and others”, he pointed out. Audisio rejected the idea of deliberate age discrimination but admitted that treating elderly patients with cancer can be complex. “There is little consensus on how elderly patients with cancer should be assessed and treated as this population is excluded from clinical trials that provide evidence of efficacy for cancer therapies”, he noted. Although elderly patients with cancer are generally fitter than older patients with orthopaedic or cardiovascular diseases and respond well to cancer treatments— particularly surgical procedures— aggressive and potentially curative treatments might be poorly tolerated in those who are frail. With no evidence-based guidelines for assessment of elderly patients with cancer and no well-validated cancer management protocols,
rapid and reliable assessment instruments have become essential. Fast screening tests, taking 3–5 min, have been developed, and can separate frail patients who need to be investigated further and discussed with geriatricians from the larger majority (80–85%) who are reasonably fit and do qualify for active treatment. “Health professionals recognise their responsibility to offer the most appropriate therapeutic opportunity to any cancer patient who needs it, regardless of their chronological age. The big challenge is to continue to raise awareness of cancer to prevent elderly patients being diagnosed very late; the less the fear, the earlier the diagnosis, the more effective the treatment, no matter what the age of the patient”, he stressed.
Will & Deni McIntyre/Science Photo Library
Ageism and cancer treatment: fallacy not fact
Published Online January 4, 2013 http://dx.doi.org/10.1016/ S1470-2045(12)70586-7 For more on the survey see http://www.macmillan.org.uk/ Aboutus/News/Latest_News/ AGEISMINNHSSTOPPINGOLDER CANCERPATIENTSGETTINGBEST TREATMENT.aspx For reviews of screening tests for the elderly see Ecancermedicalscience 2012; 6: 243 and Lancet Oncol 2012; 13: e437–44
Kathryn Senior e48