Lung Cancer Survival Affected by Age, Gender
Reported February 15, 2010
(Ivanhoe Newswire) — The biology of lung cancer differs from one patient to the next, depending on age and gender, which may help explain why certain groups of patients do better than others even though they appear to have the same disease.
Senior author Anil Potti, M.D., oncologist in the Duke Institute for Genome Sciences & Policy (IGSP), was quoted as saying, “Our study supports two key findings: First, the biology of lung cancer in women is dramatically different from what we see in men. Women, in general, have a less complex disease, at least in terms of the numbers of molecular pathways involved. We also discovered that there is a subset of elderly patients who would probably benefit from treatments that we’ve normally reserved for younger patients.”
Potti said that in the past, physicians have had to rely on very rough measures to categorize patients’ lung cancers, factors such as the size of the tumor, the tissue type and the degree to which the cancer had spread. “But this new information tells us that we can analyze patients’ disease much more discretely,” said Potti.
Potti and a team of researchers in the IGSP studied clinical data and accompanying genomic information obtained from tumors of 787 patients with predominantly early stage non-small cell lung cancer (NSCLC), the most common form of the disease. They gathered tumor samples and corresponding microarray data showing which genes were activated in the tumors, then selected twelve of the most common molecular pathways that become dysregulated in NSCLC. The goal was to identify any patterns linking the pathways to age, gender and time to recurrence. They sorted the patients by age and gender and then again into low- and high-risk groups, based on five-year, recurrence-free survival.
They found that certain molecular pathways were more frequently activated in some groups than in others and that certain pathway patterns were associated with better long-term survival in lung cancer patients.
Specifically, they found that high-risk patients those with the shortest time to recurrence were significantly more likely to have increased activation of the pathways responsible for tumor metastasis and necrosis, when compared with low-risk patients.
High-risk patients 70 or older were found to have higher activation of pathways regulating blood supply and invasiveness. In comparing high-risk women to high-risk men, the researchers found that men were more likely to have a much more complex pattern of multiple pathways being activated than women with the same type of lung cancer.
The study also identified a subset of patients over age 70 who had a low-risk profile. Potti said that is important because people over age 70 are generally not included in many clinical trials, and physicians often hesitate to offer them the option of conventional chemotherapy. “The thinking has been that they may not withstand the treatment or benefit from it much, said Potti. But now we know that it probably makes sense to consider treating this population by risk-stratifying the disease.”
Study co-author Jeffrey Crawford, M.D., chief of medical oncology at Duke, was quoted as saying, “People still don’t realize how bad a disease this is. Lung cancer kills more than 150,000 patients each year in the U.S. more than breast, prostate, colon and ovarian cancer combined. Unfortunately, there is a patient dying from lung cancer every three minutes in this country. So being able to better understand the disease and stratify patients by their individual molecular profiles means we can do a much better job pairing the right drug with the right patient.”
SOURCE: Duke University Medical Center, February 9, 2010