ASCO 2013 – clinical trials for older cancer patients

Clinical trials are vital for improving treatment for people with cancer

In our second report from this year’s ASCO conference, Trevor Bott writes about a session he attended on the need for clinical trials for older cancer patients.

People are living longer thanks to improved living standards and phenomenal medical progress in recent decades. That’s the good news.

But our aging population comes at a price: the biggest risk factor for cancer is old age, so the flipside is that the number of people developing cancer is set to soar.

Estimates vary, but an older population definitely means many more elderly men and women with cancer in future – one speaker said that by 2030 the incidence of cancer in the US will rise to 67 per cent in the over 65s compared with just 11 per cent in the under 65s.

That’s why ASCO put on a session about clinical trials for older patients. Such trials – which form the backbone of medical progress – are crucial if we’re to find the best way to treat the increasing number of older people with cancer.

Yet doctors don’t routinely ask older patients if they want to be enrolled on a clinical trial, because they are wary of the potential side effects of the drugs. They’re also concerned about how the treatment might affect other medical conditions that elderly patients may have.

In the 21st century, age is not necessarily a good indicator of fitness, and older people should not be denied the best treatment simply because of their age.

The overriding sentiment of this fascinating session was that we need to move away from an outmoded culture of broad-brush rejection of clinical trials for older patients, and to an era where we better understand the special considerations required for elderly patients on trials.

Many clinical trials exclude people over a certain age, or with concurrent medical conditions. This means that we know less about how cancers behave in older people and less about how well treatments may work. If we designed more trials specifically for older people we could look at things like:

• How cancers behave differently in the elderly;
• Designing trial end points specifically for older patients (so rather than measuring how long it takes for disease to progress for instance, use more appropriate end points such as ‘TWiST’ – Time Without Symptoms or Toxicity);
• Using functional age instead of chronological age (that is, ‘how fit’ the person is, rather than ‘how old’);
• Different ways of treating cancers, such as starting with lower doses of medication and slowly increasing;
• Enrolling older patients in smaller ‘sub-trials’ within bigger trials, so that considerations like those above could be included in the trial design.

Finally, we heard that given the chance, many elderly patients would take part in a clinical trial. In a survey, 75 per cent of patients over 70 said they would be willing to take part.

Increasingly, trials are being designed specifically for older people, such as the HCQ trial, supported by Cancer Research UK.

But the message from doctors and patients is loud and clear. We need more clinical trials designed to meet the needs of the majority of our patients – older men and women.

Trevor Bott, Clinical Trials Database Nurse