Therapeutic options in older patients with metastatic non-small cell lung cancer

Abstract

Abstract:The increase in life expectancy, with its concomitant increase in the risk of cancer, has led to an increased incidence of lung cancer in older people. The median age at diagnosis of lung cancer is between 63 and 70 years. For a long time, there has been a pessimistic attitude by doctors, patients and their relatives and thus an undertreatment of older patients. Older patients have some specific differences compared with younger patients: more comorbidities with concomitant medications that may interfere with chemotherapy, geriatric syndromes, frailty and so on. The first trial devoted to older patients with advanced nonsmall cell lung cancer (NSCLC) was a comparison between vinorelbine and best supportive care. There was a significant benefit of survival in the chemotherapy arm. Doublet therapy with gemcitabine plus vinorelbine did not give better results than either of these drugs alone. Thus, the recommendations for the treatment of older patients with advanced NSCLC were to give monotherapy. In some clinical trials not dedicated to older patients it appeared that patients might benefit from platinum-based doublet therapy like their younger counterparts. A randomized trial conducted by the French intergroup, IFCT, in patients aged at least 70 years comparing vinorelbine or gemcitabine alone with monthly carboplatin combined with weekly paclitaxel demonstrated that there was a highly significant benefit of survival in the doublet arm. This study resulted in a modification of the recommendations on the treatment of older patients with advanced NSCLC.

Treatment Toxicity in Elderly Patients With Advanced Non–Small Cell Lung Cancer

“…Although most RCTs were initially focused on younger adults, there is growing evidence supporting the use of chemotherapy and RT in elderly patients with advanced NSCLC [9, 21–31]. The first RCT specifically focused on older patients (n=191), conducted by the Elderly Lung Cancer Vinorelbine Italian Study Group (ELVIS), found that single-agent chemotherapy, compared to supportive care, offered a survival benefit [26].…”

Quantitative Proteomic Analysis of Optimal Cutting Temperature (OCT) Embedded Core-Needle Biopsy of Lung Cancer

“…SqCC is an aggressive subtype accounting for 25 – 30% of NSCLC cases, making it the second most common type of lung cancer [2]. SqCC is notoriously difficult to treat as patients tend to be older, present with advanced disease and have centrally located tumors [3, 4]. Smoking is strongly associated with SqCC requiring clinical attention to other comorbidities when considering therapeutic options [5].…”

Meta-analysis comparing doublet and single cytotoxic agent therapy as first-line treatment in elderly patients with advanced nonsmall-cell lung cancer

“…Because of these limitations it could not be concluded that platinum-based doublet therapy should be considered as first-line treatment in patients aged >70 years of age. (3) The results of the present systematic review may be influenced by four large trials, 7,8,19,22 which may be responsible for the lack of survival benefit seen in East Asian patients. It is possible that even after pooling the data, the power may have been inadequate to detect a difference.…”

“…In previous studies, a cut off has been set at 65 years of age, particularly in epidemiological studies, but this is problematic as the median age of lung cancer diagnosis is 70-71 years. 19,28 The cut off for entry into therapeutic trials is usually 70 years of age, probably because treatment may not require age-related adaptation before this age cut off; 19,28 (2) The treatment schedules differed between the included trials. Because of these limitations it could not be concluded that platinum-based doublet therapy should be considered as first-line treatment in patients aged >70 years of age.…”

“…Eleven publications were finally included for analyses (Figure 1; 13 trials and 2 782 patients. [5][6][7][8][19][20][21][22][23][24][25] All included trials, together with their related Jadad scale scores, are shown in Table 1.…”