Treatment of older patients with advanced non-small cell lung cancer: A challenge

J Geriatr Oncol. 2019 Jul;10(4):528-533. doi: 10.1016/j.jgo.2018.09.008. Epub 2018 Oct 6.

Abstract

With a median age of 70 years at diagnosis, lung cancer is a disease of older persons. As a consequence oncologists are confronted with an increasing older lung cancer population for which treatment decisions are needed. In the past years, the therapeutic landscape of advanced non-small cell lung cancer (NSCLC) has changed impressively with the introduction of targeted therapies and immunotherapy next to chemotherapy. Treatment choices for advanced NSCLC are mainly guided by different tumor-related characteristics. However, in older patients treatment decisions are more complex because of the scarcity of data from large randomized studies in older patients and the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity and polypharmacy. The present manuscript reviews available data for the different treatment options for older patients with NSCLC as well as the use of geriatric assessment as an evaluation and guidance tool.

Keywords: Chemotherapy; Geriatric assessment; Immunotherapy; Older patients with lung cancer; Targeted therapy; Treatment.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / genetics
  • Adenocarcinoma / pathology
  • Aged
  • Anaplastic Lymphoma Kinase / genetics
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Squamous Cell / drug therapy
  • Carcinoma, Squamous Cell / genetics
  • Carcinoma, Squamous Cell / pathology
  • Clinical Decision-Making
  • ErbB Receptors / genetics
  • Geriatric Assessment*
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / genetics
  • Lung Neoplasms / pathology
  • Molecular Targeted Therapy
  • Mutation
  • Patient Selection*
  • Protein Kinase Inhibitors / therapeutic use*
  • Proto-Oncogene Proteins B-raf / genetics
  • Translocation, Genetic

Substances

  • Antineoplastic Agents
  • Antineoplastic Agents, Immunological
  • Protein Kinase Inhibitors
  • ALK protein, human
  • Anaplastic Lymphoma Kinase
  • EGFR protein, human
  • ErbB Receptors
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf