Today I saw a poster discussion titled "Elderly patients with lymphoma and myeloma can effectively participate in clinical trials of novel agents." Duh. Also, a recent Italian study shows that Revlimid added to melphalan and DEX improves the response rate and probably the overall survival. Further, when Revlimid was added as maintenance, the progression-free survival was significantly enhanced over melphalan and DEX alone. Another trial showed a similar advantage when Velcade was added to melphalan and DEX instead of Revlimid. Just like regular folks.
Some precautions may be necessary. Researchers have developed several different procedures for assessing a patient's physical and functional capacity. They find that function (ability to live independently) is an independent predictor of survival. Other serious health problems (heart, diabetes, etc.) also predict poor survival.
Some nuggets from a session titled: "Geriatric Oncology: The older Cancer patient":
- "Cure" means to live long enough to die of something else.
- Many older patients have five or more OTHER serious illnesses.
- Older patients do not necessarily experience higher toxicity from novel drugs.
- One speaker said we need more studies, and then "Please hurry - I'm aging fast!"
- "Older" means 60 to 79. No one even thinks about people over 80. You're on your own.
- Yet the median age for newly-diagnosed patients is about 65 (I think, my comment).
- For patients over 75, use reduced dosages, e.g. thalidomide 50 mg instead of 100 or 200.
- For relapsed/refractory patients, try all of the approved drugs, and when all else fails, put them on a trial! (Just like anyone?).
Lunch aboard Amtrak: Spinach salad with cold salmon. Tasty, healthful, and served graciously. About $9.00.