Une ≪ population spéciale ≫ : les sujets âgés

Abstract

The subjects aged 70 years and over account for nearly 50 % of patients with non-small cell lung cancer (NSCLC). This is a “special population”, because of its potential frailty. Elderly patients should receive a careful assessment in order to evaluate the risk of mortality (related to NSCLC or comorbidities) and the risk of treatment toxicity. The Comprehensive Geriatric Assessment (CGA) is probably useful in this setting, as well as geriatric screening tools. Lobectomy is the standard treatment for localized NSCLC, but more limited resections may be considered. Radiotherapy with curative intent, in particular stereotactic body radiotherapy, and radiofrequency ablation are alternatives to surgery. Definitive radiotherapy and sequential chemo-radiotherapy are reasonable therapeutic options for locally advanced NSCLC. In the absence of molecular alteration, the combination of carboplatin and weekly paclitaxel is recommended as first-line treatment for metastatic NSCLC in elderly patients with good performance status and limited comorbidities. For unfit elderly patients, single-agent chemotherapy is preferred. EGFR tyrosine kinase inhibitors and crizotinib are the treatment of choice in patients with EGFR mutation-positive tumors and ALK-rearranged tumors, respectively.