title: Do elderly patients with non-small cell lung cancer get the best out of recent advances in first-line treatment? A comparative study in two tertiary cancer centers in Greece.
abstract: BACKGROUND
  Elderly patients with advanced non-small cell lung cancer (NSCLC) are thought to receive suboptimal treatment mainly due to concerns for poor compliance and/or excessive toxicity.
  
  
  METHODS
  Using the age of 70 years as the pre-defined cut-off, we compared elderly patients with advanced NSCLC suitable for first line chemotherapy with their younger counterparts in terms of: i) diagnosis and disease characteristics ii) adherence to treatment schedule, including dose intensity (DI), and relative dose intensity (RDI), iii) toxicity, tolerance, and efficacy outcomes.
  
  
  RESULTS
  Among 292 eligible patients, data were available for 245, of whom 107 (43.7%) belonged to the elderly group. This group was more likely to present with co-morbidities, non-smoking current status and diagnosis based on cytology alone. As compared to the non-elderly, elderly patients were more likely to receive single-agent therapy (8.0% vs. 29.2% respectively, p < 0.001) and less likely to receive platinum-based chemotherapy (80.3% vs. 57.9%, p < 0.001). Elderly patients also received docetaxel (24.3% vs. 40.4%), and bevacizumab (7.5% vs. 21.3%) significantly less often and received oral vinorelbine (24.3% vs. 11.8%) more frequently. Non-elderly patients were more likely to receive any of the cytotoxic drugs with RDI > 0.8 (49.6% vs. 33.0%, p = 0.012) and RDI > 0.9 (29.6% vs. 16%, p = 0.015). Substantial toxicity, as well as median overall survival did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  Only one third of the elderly patients received at least 80% of the scheduled treatment intensity. Nearly half received diagnosis based on cytology alone, which may deprive them from new, histology-driven, therapeutic approaches.
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece; "Alexandra" University Hospital, Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
authors.forename: Marios
authors.initials: M
authors.lastname: Bakogeorgos
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece; "Alexandra" University Hospital, Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece. Electronic address: gmountzios@gmail.com.
authors.forename: Giannis
authors.initials: G
authors.lastname: Mountzios
authors.affiliation: "Alexandra" University Hospital, Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Bournakis
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Economopoulou
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece.
authors.forename: Giannis
authors.initials: G
authors.lastname: Kotsantis
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Fytrakis
authors.affiliation: Health Data Specialists Office, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kouvatseas
authors.affiliation: "Alexandra" University Hospital, Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
authors.forename: Meletios-Athanassios
authors.initials: MA
authors.lastname: Dimopoulos
authors.affiliation: 251 Airforce General Hospital, Department of Medical Oncology, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kentepozidis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D000077143:Docetaxel; D004305:Dose-Response Relationship, Drug; D005260:Female; D006115:Greece; D019983:Guideline Adherence; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D043823:Taxoids / Q000008:administration & dosage; D062606:Tertiary Care Centers; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D000068258:Bevacizumab; D014747:Vinblastine; D000077235:Vinorelbine
keywords: Adherence; Chemotherapy; Efficacy; Elderly patients; NSCLC; Tolerance