Abstract
Non-small cell lung cancer (NSCLC) may be considered typical of advanced age. More than 50% of NSCLC patients are diagnosed over the age of 65 and approximately one-third of all patients with non-small cell lung cancer (NSCLC) are over the age of 70. Elderly patients tolerate chemotherapy poorly compared to their younger counterpart because of the progressive reduction of organ function and comorbidities related to age. For this reason, these patients are often not considered eligible for aggressive cisplatin-based chemotherapy, the standard medical treatment of advanced NSCLC. At present, for early stages there are no indications for adjuvant and neoadjuvant chemotherapy. Combined chemo-radiotherapy in locally advanced disease, particularly with concurrent approach should be investigated in specific trials before to be preferred in clinical practice to radiation therapy alone. In advanced disease, prospective phase II trials have demonstrated suitable toxicity profile and good antitumor activity for single agent chemotherapy with the recently developed drugs vinorelbine, gemcitabine and taxanes. Moreover, vinorelbine, compared to best supportive care in a phase III randomized trial, has proven to improve survival and quality of life. A phase III randomized trial showed that polychemotherapy with gemcitabine and vinorelbine does not improve any outcome as compared to single agent chemotherapy with vinorelbine or gemcitabine. In clinical practice, single agent chemotherapy should remain the standard treatment. Feasibility of cisplatin-based polychemotherapy remains an open issue and has to be proven prospectively. The two main research-lines to explore in the near future are the introduction of biological agents in the treatment schemes and the development of specifically designed schedules of platin-based regimens. However, practicing a multidimensional geriatric asessment for individualized treatment choice in NSCLC elderly patients is mandatory.
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