CONVERT Trial: Concurrent Chemoradiotherapy to Treat Elderly Patients With Limited-Stage SCLC
Elderly patients with limited-stage small cell lung cancer (SCLC) showed similar survival and toxicity compared to younger patients when treated with concurrent chemoradiotherapy. These study findings were published by Christodoulou et al in the Journal of Thoracic Oncology.
SCLC constitutes between 10% and 15% of lung cancer diagnoses, and of those, 30% are characterized as limited-stage disease (or stage I–III, according to the TNM classification). The elderly make up a large population of patients diagnosed with limited-stage SCLC, but they are often underrepresented in clinical trials and have few treatment options. Consequently, the optimal treatment for elderly patients with limited-stage SCLC is not established and warrants further investigation.
CONVERT Trial
A group of international investigators compared the outcomes of patients aged 70 years or greater to their younger counterparts within the Concurrent ONce-daily VErsus twice-daily RadioTherapy (CONVERT) trial, an international, multicenter, phase III randomized controlled trial. There was no upper age limit in the CONVERT trial, and patients were followed for 5 years after treatment.
Patients were randomly assigned to receive radiotherapy at 45 Gy in 30 twice-daily fractions for 3 weeks or 66 Gy in 33 once-daily fractions for 6.5 weeks concurrently with platinum-based chemotherapy. Overall survival and progression free survival were evaluated using Kaplan-Meier methodology and Cox proportional hazards regression.
Between April 2008 and November 2013, 547 patients were enrolled in the study. Of the 490 patients included in this analysis, 67 were aged ≥ 70 years, with a median age of 73 years (range = 70–82 years), 21 patients were aged ≥ 75 years, and 4 patients were aged ≥ 80 years. The median age of the younger group was 60 years (range = 29–70 years). Among the patients ≥ 70 years, 20 (43%) were randomly assigned to twice-daily radiotherapy and 38 (57%) were assigned to once-daily radiotherapy.
Study Findings
Median survival in the elderly vs younger groups was 29 months (95% confidence interval [CI] = 21–39 months) vs 30 months (95% CI = 26–35 months). Median time to progression in the elderly vs younger groups was 18 months (95% CI = 13–31 months) vs 16 months (95% CI = 14–19 months).
Fewer older patients received the optimal number of radiotherapy fractions (73% vs 85%; P = .03). However, chemotherapy compliance was similar in both groups (P = .24).
Neutropenia grade 3 or 4 occurred more frequently in the elderly compared to the younger group (84% vs 70%; P = .02), but rates of neutropenic sepsis (4% vs 7%; P = .07) and death (3% vs 1.4%; P = .67) were similar in both groups.
The authors concluded, “This analysis is the largest chemoradiotherapy randomized trial reported in elderly [patients with limited-stage] SCLC and we demonstrated comparable survival and toxicity between older and younger patients. Certainly, up to age of 80, chronological age as a sole factor should not be a barrier to this type of treatment. In CONVERT, hematological toxicity was higher in the elderly but there was no increased risk of neutropenic sepsis or hospitalization, and fatal toxicity was similar in the two age groups. However, the small group of patients aged ≥ 80 years experienced severe toxicity including one treatment-related death reported as dementia from percutaneous coronary intervention. Overall, our results are particularly relevant as robust evidence to guide treatment decisions in elderly [patients with limited-stage] SCLC is lacking.”
Disclosure: See study authors’ full disclosures at jto.org.
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