Saturday, June 5, 2010

Older Patients Are (almost) Like Anyone Else

The standard of care for newly-diagnosed older patients (60 and over - is 60 elderly?) has been treatment with melphalan and dexamethasone (DEX), especially in Europe. The "novel" drugs, thalidomide, Revlimid, and Velcade have not been used for older patients as much as they might, because there was no data showing that they were safe and effective for older patients. (Are they safe and effective for anyone?) By the way I'm 69, so this is a subject dear to my rickety old heart.

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?).
So, if the definition of cure is to live long enough to die of something else, then we most-mature adults have a much greater chance of being cured. Celebrate that!

Lunch aboard Amtrak: Spinach salad with cold salmon. Tasty, healthful, and served graciously. About $9.00.
Lunch on Amtrak


  1. I can't help but wonder if dying of something else is also a result of taking the maintenance chemo (e.g. Revlimid). That's still my biggest concern.

    Perhaps they should step back and instead of using the generic term "we will knock them into remission and hope to give them a good quality of life" they should think "good health, vitality, longevity". In that order.

    If they think about those values as they develop the drugs, perhaps the drugs would be less toxic?

    Also, Don - why IS Revlimid still so expensive? Is there a forum for you to ask that?

    Thanks for your insightful comments. So many of us rely on your eyes & ears at this conference.

  2. Hi Hanna,

    Every time we see Celgene reps at the support group meeting we ask that question, and they always mumble something about how expensive it is to develop new drugs with all the trials and so forth.

    Personally I think they just charge what the traffic will bear.

    If you don't have insurance, or have a large copay, by all means do contact LLS and other organizations that will help. Contact your local Celgene representative, who can help guide you through that.