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These data support our previous preclinical and clinical observations that dexamethasone pre-treatment decreases hematopoietic toxicity and improves efficacy of this chemotherapeutic regimen in patients with metastatic non-small cell lung cancer and suggests that further randomized trials should be undertaken.

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Lung cancer is a disease of the elderly, with a median age at diagnosis of 70 years. However, there is a dearth of good quality evidence to guide treatment in this population and most of the data are extrapolated from younger patients. Current research is directed toward establishing simplified instruments to quantify fitness of older patients for various forms of therapy. Although current evidence suggests that outcomes after standard therapy are similar to those seen in younger patients, older patients have an increased incidence of adverse events. Until better predictive markers are available to guide treatment, therapy should be individualized using available instruments, including a comprehensive geriatric assessment. If an older patient is deemed to be fit, it is reasonable to use the treatment options recommended for younger individuals. This article summarizes the available data on the treatment of non-small cell lung cancer in the older patient.

By 2030, researchers estimate that 20% of the U.S. population will be 65 years or older. More than 50% of all new cancers in the United States occur in this patient population. In addition, the increased incidence and prevalence of cancer in older patients and the increased lifespan of older adults mean that cancer in older individuals is becoming an increasingly common problem. Specific issues include geriatric screening and assessment, preventing or decreasing complications from therapy, accounting for disease-specific issues, and managing patients who cannot tolerate standard treatment. The NCCN Senior Adult Oncology Panel has developed guidelines for addressing these issues and for assessing the risks and benefits of treatment in older patients with cancer. For the most recent version of the guidelines, please visit NCCN.org