Older adults ignored often in clinical trials for lung cancer

Due to eligibility criteria and enrolment restrictions on comorbidities typically associated with ageing, clinical trials often exclude older adults with advanced lung cancer, leading to poor generalizability of existing trial evidence to this population, a recent study has found.

The researchers conducted a population-based analysis of 677 older adult patients (median age 84 years, 65.6 percent men) who had been diagnosed with metastatic lung cancer. Trial-typical patients were defined as those who lacked the following comorbidities: inadequate organ function, cognitive dysfunction, poor performance status, and malignancies in the past 5 years.

Overall, 53.4 percent of the participants were deemed to not be trial-typical and would have been excluded had they been up for enrolment in clinical trials. These participants had at least one of the identified comorbidities and/or had poor performance status. Twenty-three percent of participants satisfied at least two exclusion criteria.

Stratifying according to age group, the researchers found that younger participants tended to be more trial-typical than their older counterparts (65–74 vs 75–84 and ≥85 years: 66.7 percent vs 43.2 percent and 41.8 percent). Men were also less likely to be trial-typical than women. Both demographic indicators remained statistically associated with being trial-atypical in multivariable analysis.

“Most older adults with metastatic lung cancer would not be considered typical trial participants based on comorbidities, performance status, and prior cancer history,” the researchers said. “The poor generalizability of existing trial evidence to older adults with lung cancer likely contributes to their low treatment uptake rates, highlighting the need for more effective evidence-based therapies for these patients.”