According to two recently published studies, advanced age should be no barrier to treating patients with inoperable lung cancer. In both studies, otherwise healthy patients who were over 70 years old had the same survival as did their younger counterparts.

Nearly 50% of people with lung cancer are 70 or older. This makes it important to know whether treatment that works for younger patients will work for them, too.

In the first study, published in the journal Cancer (Vol. 98, No. 4: 779-788), researchers from the University of North Carolina, Chapel Hill, and Northwestern University treated 239 patients for inoperable lung cancer. Sixty-seven of the patients were 70 or older. All the patients received chemotherapy with the drugs carboplatin and paclitaxel.

The study was trying to learn if the chemotherapy could be limited to just four courses or whether it needed to be given indefinitely until the cancer began growing again. Half the patients received the four courses and the other half were treated until the cancer progressed.

The researchers found that four courses were enough. The extra chemotherapy didn’t increase survival.

The other discovery was that the patients over 70 years old had the same benefit from the chemotherapy as younger patients. Their quality of life was no different, and their cancer shrank just as often with the chemotherapy. Likewise, they lived as long with their cancer as did the younger patients.

One concern with older patients is that they can't tolerate chemotherapy as well. This wasn't true in this study. The older patients experienced no more toxicity than the younger ones.

"There is growing evidence that advanced age alone is a poor predictor of the ability of an individual patient to tolerate and benefit from chemotherapy," wrote lead researcher Thomas Hensing, MD.

In the second report, however, toxicity was a problem for some of the elderly patients. Researchers from the Mayo Clinic and other institutions published their findings in the Journal of Clinical Oncology (Vol. 21, No. 17: 3201-3206). In their study 244 patients were treated with a combination of chemotherapy and radiation. Of these, 63 were 70 or older.

The older patients experienced more severe side effects from the treatment. Most of this was related to their blood count, which fell to lower levels than in the younger patients. A more serious problem was that four older patients developed serious pneumonia compared to only one patient in the younger group.

On the positive side, the cancer was controlled just as well in the older patients. Both the time it took for the cancer to start growing and survival were the same for both groups.

Lead researcher Steven Schild, MD, says doctors must monitor elderly patients carefully because of the potential for more severe side effects from treatment. But he, too, notes that age shouldn't be a reason to exclude patients from treatment.

"Fit elderly patients need not simply be relegated to palliative therapy or no therapy just because they are older than 70," he said in a statement. "These patients should be fully briefed on the range of treatment options, including potential risks and benefits."

Both groups of investigators point out that more clinical trials that include the elderly are needed to learn how to best treat this group of patients.

Some experts are even calling for separate studies specifically for elderly patients. In an editorial accompanying Schild's paper, Lecia Sequist and Thomas Lynch, of Harvard Medical School, say this type of trial would give doctors needed information about how older people react to chemotherapy and radiation.

Currently, very few elderly patients enroll in clinical trials, compared to the number of elderly people who develop cancer. Because of that, the editorialists say, the conclusions doctors can draw about toxicity may not accurately reflect how the majority of older patients fare.

"Only by performing elder-specific studies will we be able to treat patients who are more representative of the population of patients older than 70 years, and not just the 'fit elderly,'" they conclude.