Recent Advances in Systemic Therapy for Non-Small Cell Lung Cancer in Elderly Patients

Abstract

Objective: Our aim was to review and provide updated information about recent advances in systemic therapy for treatment-naive elderly patients with non-small cell lung cancer (NSCLC).Methods: We reviewed clinical trials, including those we conducted ourselves, of first-line chemotherapy regimens and targeted agents involved with recent advances in systemic treatment options for elderly patients. Such chemotherapy regimens and agents were identified using Medline and through review of relevant presentations at international conferences, which addressed the elderly in particular or provided subgroup information by age.Results: Similar to the approach taken in younger patients, NSCLC patients of all ages should be assessed to ascertain the presence of either tumor epidermal growth factor receptor (EGFR)-active mutation or anaplastic lymphoma kinase (ALK) rearrangement. For patients with EGFR active mutations, an EGFR-tyrosine kinase inhibitor (TKI) could be given as first-line treatment, and crizotinib for patients with an ALK rearrangement. Patients with a wild-type or unknown EGFR and ALK mutation status can be treated with either a single agent, or platinum-based or non-platinum-based doublets. The response rates and median survival times of fit elderly NSCLC patients receiving appropriate chemotherapy, including single-agent, or combination treatment, were no worse than those of younger patients. Physically fit elderly patients may receive platinum-based adjuvant chemotherapy after surgical treatment, if the pathological staging was stage II or III.Conclusions: Advanced age alone should not preclude systemic therapy. Either targeted therapy or chemotherapy should be considered for selected elderly patients with NSCLC who are sufficiently fit.