The treatment of haematological cancer in older patients

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Published: 13 Feb 2011
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Prof Sergio Amadori - Tor Vergata University Hospital, Rome, Italy
Prof Sergio Amadori speaks about the upcoming ecancer meeting on blood cancers in elderly patients which will be held in Rome, 18-20th March 2011. Prof Amadori explains how the meeting will help educate clinicians of the issues that must be addressed when treating older cancer patients and the treatment options available. Prof Amadori goes on to outline which clinicians would benefit most from attending this meeting and discuss how the difference between the chronological and biological age should be taken into account when identifying treatment options.

Speaker key

 

MO       Moderator

SA        Sergio Amadori

 

 

MO       Now, Sergio, in Rome, your very city, there's going to be an important event in March looking at blood cancers in the elderly.  You're on the steering committee.  You're an expert on elderly blood cancers.  Tell me, what, as a member of this steering committee, you have in store for us.

 

SA        You know, we... I... we think it's very appropriate to discuss the problem of cancer in older people.  I'm an expert on haematological malignancies, including leukaemia, lymphomas, myeloma.  And these are still, I would say, a, sort of, unmet medical need in this population of patients in the sense that nowadays, in spite of the progress made over the last... especially during the last decade, the prognosis of many of these diseases in older patients continue to be very, very poor.

 

MO       So what are the issues that you're going to be addressing in Rome?

 

SA        The issue in particular will be acute leukaemias, myelodysplastic syndromes, which are a common cancer, especially in older people.  Typically, the median age of these diseases is around 68, 70 years.  And these diseases, we know require intensive treatment to be put under control.

 

MO       Why is it necessary to have a meeting specifically to discuss these diseases in older patients?

 

SA        Yes because we want to inform people, we want to inform doctors that there are new opportunities also in this age group.  You know, this age group is often neglected.  It's often considered not eligible for anything, just palliation treatment, especially in these categories of very aggressive diseases like AML, especially AML, for example.  Because the common theme is that these patients are probably too frail from a physical point of view, they have co-morbidities, they cannot tolerate the treatment since we know that intensive treatment is the key in the final success of this treatment.  So many times, these patients are kept aside from clinical investigation, clinical trial.  If you look at clinical trial, you'll see in this area that the median age of the patient is far lower than the actual median age of the patient affected by these diseases.

 

MO       And the older age can so often be an exclusion criterion.

 

SA        Well, you know, there are many trials which exclude patients with age over 60, for example, or for trial which can include elderly people.  You know, sometimes there are some, you know, subset which are excluded, for example patients above the age of 75 or patients with some co-morbidities which are, you know... this is a common theme in that age group.  You know, you can have some co-morbidities which can... may become a reason for exclusion of these patients from these trials.

 

MO       And what's the big message of hope, that you think there really is something that can be done and greatly improved?

 

SA        Yes, the big message is that now there is... thanks to the progress in understanding the biology of the disease, especially in older patients, we can address the disease in a much more scientific, I would say, way, trying to offer also to these patients the opportunity to be treated with new agent, with new target agent in particular, which can be applied also in this age group.

 

MO       And which clinicians are you trying to reach most of all to actually attend the meeting or follow it?

 

SA        Well, I imagine that the majority of the clinicians will be, you know, haematologists, oncologists, internists, so people working, you know, in this area and especially with older patients.  We want to convey the message that there is something, you know, new and something positive also for this population of patients.  They should no longer be considered as people who cannot be treated at all or cannot be exposed to new investigational agents.

 

MO       So there seems to be a difference between how we regard a patient between the chronological age and the biological age of the patient.

 

SA        Yes, I totally agree.  Chronological age, per se, should not be any longer a criteria for excluding patients from, you know, clinical trials where new strategies and new options could be tested.  Why so?  Because we see, in the everyday practice, people in the... you know, greater... with an age greater than 80 years, for example, in very good shape.  You do all the tests and you see the heart is doing well, the liver is doing is well, the kidneys are working properly, so there is no reason why those patients should be excluded. 

 

Of course, when you are, you know, facing a patient with an age, typically, it's said, about 60 to 65, so almost our age, I believe, so the patient should be investigated in... you know, properly to understand whether there are co-morbidities.  The real point is the identification of co-morbidities.  So the physician has to work on the patient to try to see whether there are co-morbidities which could jeopardise, you know, the life of the patient and the effect of the treatment.  But chronological age is not closely related to that.  It's not... there is no direct relationship between number of years and co-morbidities. 

 

So I think this is a very important point which will be stressed during the meeting.  I presume, for example, that Professor Lodoviko Balducci, you know, a geriatric haematologist from Tempe Bay... he's an expert in this area.  And we... he... for sure, we stress this concept.  Chronological age, in very simple terms, chronological age should not be a requisite for exclusion of anyone from, you know... to be... for being treated with new agents and new strategies and so forth.  So I think everyone has the right to be, you know, treated with what is considered the front-age treatment for these diseases, of course, with the only logical acceptable exclusion of those who have, of course, important co-morbidities.

 

MO       And what's the big message of hope, that you think there really is something that can be done and greatly improved?

 

SA        Yes, the big message is that now there is... thanks to the progress in understanding the biology of the disease, especially in older patients, we can address the disease in a much more scientific, I would say, way, trying to offer also to these patients the opportunity to be treated with new agent, with new target agent in particular, which can be applied also in this age group.

 

MO       And which clinicians are you trying to reach most of all to actually attend the meeting or follow it?

 

SA        Well, I imagine that the majority of the clinicians will be, you know, haematologists, oncologists, internists, so people working, you know, in this area and especially with older patients.  We want to convey the message that there is something, you know, new and something positive also for this population of patients.  They should no longer be considered as people who cannot be treated at all or cannot be exposed to new investigational agents.  There is room for these.

 

MO       Sergio, thank you very much.  I can't wait until the meeting starts.  It sounds very exciting.

 

SA        Thank you very much.  You're welcome.