title: Medical Treatment in Elderly Patients with Non-Small Cell Lung Cancer.
abstract: Lung cancer is the leading cause of cancer-related deaths worldwide. In the USA, ≈60 % of lung cancer cases are diagnosed in elderly patients (≥65 years of age). However, elderly patients are underrepresented in clinical studies, leading to a paucity of evidence to guide treatment decisions. Several treatment barriers exist in elderly patients, including comorbidities and poor performance status. In addition, lack of reliable geriatric assessment tools and physician reluctance to treat may contribute to undertreatment in this population. For decades, systemic chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) was either omitted or given as monotherapy, frequently with significant dose reductions, potentially compromising the efficacy of these therapies. Recent analyses of elderly subgroups from multiple clinical trials provide evidence for improved outcomes associated with platinum-based doublet chemotherapies vs monotherapy. Moreover, in the new era of precision medicine, molecularly targeted therapies and more recently immune-targeting therapies (anti-PD-1 and anti-PD-L1 agents) exhibit relatively milder toxicities but superior clinical outcomes in subgroups of patients compared with conventional cytotoxic chemotherapies. Further clinical trials will be needed to confirm similar safety and efficacy profiles of these therapeutic approaches in the elderly compared with their younger counterparts. In this article, we review available evidence from clinical studies and also present expert consensus on the management of NSCLC in the elderly, including treatment in the adjuvant setting and treatment of advanced disease. Screening tools, such as the Comprehensive Geriatric Assessment, that help to identify the right population of elderly patients suitable for systemic treatment are also discussed.
authors.affiliation: Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Kamila
authors.initials: K
authors.lastname: Bakirhan
authors.affiliation: Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Janaki
authors.initials: J
authors.lastname: Sharma
authors.affiliation: Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Perez-Soler
authors.affiliation: Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. hcheng@montefiore.org.
authors.forename: Haiying
authors.initials: H
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D060890:B7-H1 Antigen / Q000037:antagonists & inhibitors*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015577:Geriatric Assessment; D006801:Humans; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D000068437:Pemetrexed / Q000627:therapeutic use; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors*; D043823:Taxoids / Q000627:therapeutic use; D014747:Vinblastine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D060890:B7-H1 Antigen; C423236:CD274 protein, human; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D043823:Taxoids; D000068437:Pemetrexed; D003841:Deoxycytidine; D014747:Vinblastine; D000077235:Vinorelbine; D000093542:Gemcitabine
keywords: Chemotherapy; Elderly; Non-small cell lung cancer