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Journal of Clinical Oncology: The Next 25 Years

H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL

To the Editor:

The former and current Editors-in-Chief highlight the magnificent job the Journal of Clinical Oncology (JCO) has done over the past 25 years in the January 1st issue of the Journal.^1-3 They certainly deserve our highest praise and commendations.

Whether it was on purpose or by chance, three of the articles in the same issue of JCO clearly indicate one of the future developments necessary to maintain the current quality of the publication. Asmis et al⁴ established that physiologic age, expressed as comorbidity rather than chronologic age, influences the outcome of chemotherapy in non–small-cell lung cancer, and Ramalingam et al⁵ showed that age is associated with increased risk of bevacizumab-related toxicity. In his enlightening editorial, Gridelli⁶ suggests that the reason for this apparent discrepancy stems from inconsistent evaluation of older individuals. In these three publications one can discern several improvements to future clinical trials to be considered by JCO:

With more than 50% of all neoplasms occurring in the 12% of the population age 65 years and older,⁷ clinical scientists need to learn how to assess older individuals in terms of life expectancy and treatment tolerance. Data based on chronologic age alone are meaningless. Fortunately, there are reliable, albeit imperfect, ways to assess physiologic age. These include geriatric assessment,⁸ functional tests as proposed by the Cardiovascular Health Study,⁶ and laboratory tests, such as inflammation markers.⁹ In future studies involving older individuals, some form of geriatric assessment should be requested by the funding agency, not unlike the way performance status or quality-of-life assessments are now routinely included in clinical trials.

Irrespective of their function, older individuals may have unexpected toxicities from new drugs.^5,10 These toxicities may best be captured in phase II trials devoted to older individuals, which should be an integral part of the development of new agents.

Given the diversity of the older population, retrospective studies remain a main source of information about older patients (as they are in other areas of geriatrics). For them to be meaningful, these analyses need to be founded on an estimate of physiologic age, which should be promoted in clinical practice.

Last but not least, when treating older individuals, preservation of functional independence should be considered as part of the clinical outcome. It was disappointing not to find this end point even mentioned in the otherwise excellent editorial by Booth and Tannock.¹¹

In conclusion, during the first 25 years of its publication, JCO has been arguably the most important tool in improving cancer treatment around the world. The challenge of the next 25 years is to provide cancer treatment to a population that is progressively aging.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: None Consultant or Advisory Role: None Stock Ownership: None Honoraria: Lodovico Balducci, Amgen, Ortho, Novartis Research Funding: Lodovico Balducci, Amgen Expert Testimony: None Other Remuneration: None

REFERENCES

1. Bertino B: The Journal of Clinical Oncology: The initial years. J Clin Oncol 26:1, 2008[Free Full Text]

2. Cannellos C: Clinical oncology: Onward and upward. J Clin Oncol 26:2, 2008[Free Full Text]

3. Haller D: Res ipsa loquitur. J Clin Oncol 26:3-4, 2008[Free Full Text]

4. Asmis T, Ding K, Seymour L, et al: Age and comorbidities as independent prognostic factors in the treatment of non–small-cell lung cancer. J Clin Oncol 26:53-58-2008

5. Ramalingam SS, Dahlberg SE, Langer CJ, et al: Outcomes for elderly, advanced-stage non–small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: Analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol 26:60-65, 2008[Abstract/Free Full Text]

6. Gridelli C: Treatment of advanced non–small-cell lung cancer in the elderly: From best supportive care to the combination of platin-based chemotherapy and targeted therapies. J Clin Oncol 26:13-15-2008[Free Full Text]

7. Yancik R, Ries LAG: Cancer in older persons: Magnitude of the problems and efforts to advance the aging-cancer res interface, in Balducci L, Lyman GH, Ershler WB, et al (eds): Comprehensive Geriatric Oncology. London, UK, Taylor & Francis, 2004, pp 38-46

8. Lee SJ, Lindquist K, Segal MR: Development and validation of a 4-year mortality index in older adults. JAMA 295:801-808, 2006[Abstract/Free Full Text]

9. Alley DE, Crimmins E, Bandeen-Roche K, et al: Three-year change in inflammatory markers in elderly people and mortality: The Invecchiare in Chianti study. J Am Geriatr Soc 55:1801-1807, 2007[CrossRef][Medline]

10. Balducci L: Cancer chemotherapy in the older person, in Balducci L, Ershler WB, DeGaetano G (eds): Blood Disorders in the Elderly. Boston, MA, Cambridge University Press, 2008, pp 225-236

11. Booth CM, Tannock I: Reflections on medical oncology: 25 years of clinical trials—Where have we come and where are we going? J Clin Oncol 26:6-8, 2008[Free Full Text]

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