title: Treatment of Elderly Patients With Non-Small-Cell Lung Cancer: Results of an International Expert Panel Meeting of the Italian Association of Thoracic Oncology.
abstract: Most patients with non-small-cell lung cancer (NSCLC) are elderly, and age has important implications for their management and treatment. In May 2014, the Italian Association of Thoracic Oncology organized an International Experts Panel Meeting with the intent to review the available evidence regarding the treatment of elderly patients with NSCLC and to discuss the implications for clinical practice and future research in this field; this article summarizes the panelists' conclusions. All patients aged more than 70 years should receive an assessment of physiologic age, including mortality and toxicity prediction. Age itself does not contraindicate adjuvant chemotherapy after resection. Elderly patients with locally advanced NSCLC should be considered for combined chemo-radiotherapy. In the advanced setting, the combination of carboplatin/paclitaxel results in prolonged survival compared with single-agent gemcitabine or vinorelbine, albeit with increased toxicity. In fit selected patients, other carboplatin-based or cisplatin-based regimens are feasible, but randomized trials specifically showing survival prolongation in elderly patients are lacking. The survival benefit for bevacizumab added to chemotherapy seems limited to patients aged less than 75 years. In unfit elderly patients, single agents are recommended. Regardless of age, patients with advanced nonsquamous NSCLC, and those who have never smoked independently of their histologic subtype, should be tested for epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement. In patients with NSCLC harboring EGFR mutation or ALK rearrangement, targeted drugs are feasible and well tolerated.
authors: Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy. Electronic address: cgridelli@libero.it.
authors: Cesare
authors: C
authors: Gridelli
authors: Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL.
authors: Lodovico
authors: L
authors: Balducci
authors: Dipartimento di Medicina Sperimentale e Clinica "F. Magrassi", Seconda Università degli Studi di Napoli, Naples, Italy.
authors: Fortunato
authors: F
authors: Ciardiello
authors: Clinical Trials Unit, Istituto Nazionale Tumori Fondazione "G. Pascale"-IRCCS, Napoli, Italy.
authors: Massimo
authors: M
authors: Di Maio
authors: Thoracic Oncology Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Enriqueta
authors: E
authors: Felip
authors: Thoracic Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors: Corey
authors: C
authors: Langer
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT.
authors: Rogerio C
authors: RC
authors: Lilenbaum
authors: Clinical Trials Unit, Istituto Nazionale Tumori Fondazione "G. Pascale"-IRCCS, Napoli, Italy.
authors: Francesco
authors: F
authors: Perrone
authors: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Suresh
authors: S
authors: Senan
authors: Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy.
authors: Filippo
authors: F
authors: de Marinis
mesh_terms: D000367:Age Factors; D000368:Aged; D000077548:Anaplastic Lymphoma Kinase; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D066246:ErbB Receptors / Q000235:genetics; D015321:Gene Rearrangement; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D009154:Mutation; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D015996:Survival Rate
chemical_list: C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
keywords: Adjuvant treatment; Geriatric assessment; Locally advanced NSCLC; Molecular testing; Platinum-based chemotherapy