NSCLC in the Elderly—The Legacy of Therapeutic Neglect

Abstract

Although the majority of patients diagnosed with non-small cell lung cancer (NSCLC) are elderly, most clinical trials available to guide care either exclude the elderly or underrepresent them. This disregard for the elderly lung cancer patient extends to the clinical realm, where the elderly with lung cancer are less likely to be treated with either curative, or life-extending, palliative therapy. Few elderly-specific phase III trials are available to provide level I evidence. However, subgroup analyses and meta-analyses of large clinical trials enrolling substantial numbers of elderly patients are available to guide care, although these are potentially subject to selection bias. These trials suggest that the fit elderly derive as much benefit from surgery, chemoradiation, and platinum-based doublet chemotherapy as younger patients across all stages of disease. For the less fit elderly, in particular those with limited performance status or significant co-morbidities, less aggressive regimens are likely preferred, with the goal of extending life and delaying or suppressing cancer symptoms. Ultimately, care decisions must incorporate knowledge of the literature, evaluation of the patient's clinical characteristics, and patient priorities. The elderly should be aggressively recruited to clinical trials, including elderly-specific trials and trials of patients with limited performance status and co-morbidities.

Prospective analysis of quality of life in elderly patients treated with adjuvant chemotherapy for non-small-cell lung cancer

“…A cut-off age of 65 was arbitrarily selected for the analysis, and the median age of the elderly group was not over 70 years. Although the age of 65 is usually considered a cut-off point to identify an elderly population within epidemiologic literature [28], the age of 70 has been frequently used as a lower limit for patient selection in clinical trials [26,29] and likewise, a cut-off age of ≥70 was used to represent the elderly in some studies [14,16]. We have also restricted the patients' enrollment to ECOG 0-1 and adequate organ function, which may not represent elderly patients in clinical practice.…”

A multicentre phase II randomised trial of weekly docetaxel/gemcitabine followed by erlotinib on progression, vs the reverse sequence, in elderly patients with advanced non small-cell lung cancer selected with a comprehensive geriatric assessment (the GFPC 0504 study)

“…Although the ELVIS trial (ELVIS Group, 1999), single-agent chemotherapy has been the rule in this setting. However, dual-agent therapy without a platinum salt seems possible for patients selected on the basis of a geriatric assessment taking comorbidities into account (Weiss and Langer, 2009). Among the available non-platinum-based chemotherapy regimens, the docetaxel/gemcitabine (DG) combination is considered one of the most promising (Georgoulias et al , 2005; Pujol et al , 2005).…”

Outcome of active anti‐cancer treatment in elderly patients with advanced non‐small cell lung cancer: A single center experience

“…With the growing elderly population and the advance of industrialization and urbanization, the number of patients being diagnosed with lung cancer has increased, and the mean age at the time of diagnosis has gradually increased. Weiss and Langer reported that the median age at diagnosis for non‐small cell lung cancer (NSCLC) was 71 years old . Forty‐three percent of patients with advanced NSCLC included in the current study were aged 70 years or over.…”