Measuring Walking Speed Failed to Predict Early Death and Toxicity in Elderly Patients with Metastatic Non-Small-Cell Lung Cancer (NSCLC) Selected for Undergoing First-Line Systemic Treatment: An Observational Exploratory Study

SIMPLE SUMMARY: Lung cancer is common in elderly adults. Onco-geriatric tools are meant to constitute a global approach designed to help oncologists to determine which elderly patients could benefit from systemic treatments, without major safety issues. This evaluation can prove to be time- and resource-consuming. The challenge is to find an easy and reproducible test, meant to guide the clinician’s decisions. Walking speed has emerged as a potential predictor of mortality in elderly cancer patients, yet data involving lung cancer patients are scarce. Our prospective exploratory study sought to determine whether walking speed would predict early death or toxicity in patients with metastatic lung cancer receiving first-line systemic intravenous treatment. Our results revealed walking speed to be numerically, yet not significantly, associated with early mortality in older metastatic lung cancer patients. Following these hypothesis-generating results, a larger prospective, multicenter study appears to be required to further investigate this outcome. ABSTRACT: Walking speed (WS) has emerged as a potential predictor of mortality in elderly cancer patients, yet data involving non-small-cell lung cancer (NSCLC) patients are scarce. Our prospective exploratory study sought to determine whether WS would predict early death or toxicity in patients with advanced NSCLC receiving first-line systemic intravenous treatment. Overall, 145 patients of ≥70 years were diagnosed with NSCLC over 19 months, 91 of whom displayed locally-advanced or metastatic cancer. As first-line treatment, 21 (23%) patients received best supportive care, 13 (14%) targeted therapy, and 57 (63%) chemotherapy or immunotherapy. Among the latter, 38 consented to participate in the study (median age: 75 years). Median cumulative illness rating scale for geriatrics (CIRS-G) was 10 (IQR: 8–12), and median WS 1.09 (IQR: 0.9–1.31) m/s. Older age (p = 0.03) and comorbidities (p = 0.02) were associated with Grade 3–4 treatment-related adverse events or death within 6 months of accrual. Overall survival was 14.3 (IQR: 6.1-NR) months for patients with WS < 1 m/s versus 17.3 (IQR: 9.2–26.5) for those with WS ≥ 1 m/s (p = 0.78). This exploratory study revealed WS to be numerically, yet not significantly, associated with early mortality in older metastatic NSCLC patients. Following these hypothesis-generating results, a larger prospective, multicenter study appears to be required to further investigate this outcome.