title: Management of elderly patients.
abstract: CONCLUSIONS
  Elderly patients are often excluded from clinical trials, yet more than two-thirds of patients diagnosed with lung cancer are over 65 years old. It is therefore important to develop specific tools and trials for this specific patient population.
  
  
  METHODS
  This chapter first examines the management specificities of elderly patients. Randomized trials specifically involving elderly patients are then described, and likely future developments are considered.
  
  
  RESULTS
  Older people have several specificities. In addition to traditional criteria such as age and performance status, other important factors include the number of comorbidities and age-related changes such as cognitive deficits and depression. Specific indices taking these factors into account have been published and validated. Single-agent therapy has been widely used to treat metastatic lung cancer in the elderly, following publication of negative results from randomized phase III trials of combination chemotherapy. Recently, however, a trial of doublet therapy gave positive results, in a subgroup of independent older patients. The benefit of patient selection based on a combination of these indices has been demonstrated in open-label and randomized trials. These results must now be confirmed in phase III trials including the use of tyrosine kinase inhibitors combined with chemotherapy.
  
  
  CONCLUSIONS
  Indices based on a combination of age-related factors, together with judicious use of biological markers, will further improve the prognosis of elderly lung cancer patients.
authors: Service de Pathologie Respiratoire, CHU - Limoges, France ; ; Groupe Français de Pneumo - Cancerologie (GFPC), France ;
authors: Alain
authors: A
authors: Vergnenegre
authors: Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France ;
authors: Romain
authors: R
authors: Corre
authors: Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France ;
authors: Hervé
authors: H
authors: Lena
authors: Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CH - Draguignan, France.
authors: Hervé
authors: H
authors: Le Caer
keywords: Elderly; geriatric assessment; management; non-small cell lung cancer