Advanced non-small cell lung cancer in elderly patients

Abstract

This article aims to provide guidelines in the management of elderly patients with advanced non-small cell lung cancer. Epidemiology of lung cancer shows the considerable increase in frequency of this disease in elderly people, with a median age at diagnosis between 63 and 70 years. Thus, there is a need for a specific and appropriate approach. Studies dedicated to elderly patients are the only means to avoid selection biases which are inherent to the studies enrolling patients of any age in clinical trials. These biases preclude any generalisability of the results observed in subgroup analyses of elderly patients. Geriatric assessment is an important component of the management of elderly patients, as performance status (PS) has been shown to be insufficient to estimate accurately the general condition of these patients. Lung cancer is the second most common cancer in males, after prostate cancer, and the third in females after breast and colorectal cancer. Also it is the leading cause of cancer-related death in males from developed or emerging countries [1] and in females in the USA since 1987, exceeding breast cancer mortality [2]. There is an exponential increase in cancer incidence with ageing and, due to the concomitant increase of life expectancy, the incidence of lung cancer in the elderly is more and more important, representing a public health problem in developed countries in which life expectancy is important. As a result, the median age of diagnosis of lung cancer (“clinical” diagnosis, histological/cytological or both) in industrialised nations is 63 to 70 years [3–7]. Non-small cell lung carcinoma (NSCLC) represents 85% of all lung cancer cases in the elderly [8–10]. This is quite similar to what is observed in their younger counterparts. However, within NSCLC, squamous cell carcinomas are …