Therapy For Advanced Lung Cancer Research Articles

A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer.

Improving health-related quality of life (hrqol) is a key goal of systemic therapy in advanced lung cancer, although routine assessment remains challenging. We analyzed the impact of a real-time electronic hrqol tool, the electronic Lung Cancer Symptom Scale (elcss-ql), on palliative care (pc) referral rates, patterns of chemotherapy treatment, and use of other supportive interventions in patients with advanced non-small-cell lung cancer (nsclc) receiving first-line chemotherapy. Patients with advanced nsclc starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their elcss-ql data before each clinic visit. Patients completed the elcss-ql at baseline, before each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data about the pc referral rate, hrqol, and use of other supportive interventions were collected. For the 95 patients with advanced nsclc who participated, oncologists received real-time elcss-ql data for 44 (elcss-ql arm) and standard clinical assessment alone for 51 (standard arm). The primary endpoint, the pc referral rate, was numerically higher, but statistically similar, for patients in the elcss-ql and standard arms. The hrqol scores over time were not significantly different between the two study arms. The elcss-ql is feasible as a tool for use in routine clinical practice, although no statistically significant effect of its use was demonstrated in our study. Improving access to supportive care through the collection of patient-reported outcomes and hrqol should be an important component of care for patients with advanced lung cancer.

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families that poses a significant risk to overall quality of life (QoL). Financial distress has been shown to be associated with increased symptom burden and decreased treatment compliance but the magnitude of financial distress is not well characterized in lung cancer populations. Patients with stage II-IV newly diagnosed lung cancer and starting first-line therapy were recruited at a tertiary academic institution between July 2018 and April 2019. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess QoL. Associations between financial toxicity and baseline variables were assessed using multivariable linear regression and correlations were assessed using the Pearson correlation. In this study, 143 consecutive patients were approached and 91.6% agreed to participate (N= 131). The median age was 65 years (35-90); 52.7% were male (n= 69), and 75.6% were white (n= 99). The inability to afford basic necessities and having <1 month of savings was associated with increased financial toxicity (P < 0.001) after adjusting for other factors such as age, race, insurance, and income. There was also a trend toward increased financial toxicity among those who were employed but on sick leave (P= 0.06). Increased financial toxicity was correlated with a decrease in QoL (correlation coefficient 0.41, P < 0.001). Patients' anticipated out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $0 to $50 000 (median $2150). However, there was no correlation between anticipated OOP expenses and either financial toxicity or QoL. These data identify key factors for identifying at-risk patients and builds a framework for exploring the benefit of financial counseling interventions, which may improve QoL and oncologic outcomes.

Financial Toxicity in Lung Cancer: An Assessment of Magnitude, Perception, and Impact on Quality of Life

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families, posing significant risk to overall quality of life. Financial distress has been previously shown to be associated with increased symptom burden and decreased treatment compliance, but the magnitude of financial distress is not well characterized in lung cancer populations. This prospective study aims to quantify the relationship between financial toxicity, quality of life, and out of pocket expenses among patients with newly diagnosed lung cancer. We present here the results of the initial enrollment period. Patients with AJCC stage II-IV newly diagnosed lung cancer, initiating first line therapy, were recruited in an IRB approved prospective study at a single tertiary academic institution. Baseline sociodemographic and household financial information was collected; Comprehensive Score for Financial Toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess quality of life (QOL). Associations between financial toxicity and baseline variables were assessed using multivariable analysis and correlations were assessed using Pearson correlation. 103 patients were approached and 97 patients were enrolled (94%) between July 2018 and February 2019. Median age was 64 years (35-90), 52% of patients were male (n=50) and 77% were Caucasian (n=75). Among our population, 39% (n=38) reported that they were either “just getting on” or “struggling” financially. 23% (n=22) had to make significant life sacrifices because they were short on money and 14% (n=14) had to use accumulated savings or retirement to pay for medical expenses. Of those patients who were not retired, 45% (n=21/47) had a change in income since their cancer diagnosis. Increased financial toxicity was associated with being unable to meet day-to-day expenses (p=0.002) and having <1 month of savings (p=0.02) after adjusting for other factors such as age, race, work status, insurance, and income on multivariate analysis. Increased financial toxicity was found to be correlated with a decrease in QOL as measured by the FACT-L (correlation coefficient [r]=0.41, p<0.001). Patients’ estimation of their out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $30-$50,000 (median $2,263). There was no correlation between anticipated OOP expenses and either financial toxicity (r=-0.18, p=0.08) or QOL (r=-0.02, p=0.86). Financial distress is common among patients with newly diagnosed lung cancer and is associated with decreased quality of life during lung cancer therapy. These data provides key factors for identification of patients at risk for financial distress. Furthermore, they provide a framework for further studies to explore the benefit of financial counseling interventions which may improve quality of life and oncologic outcomes.

Best first-line therapy for patients with advanced non-small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To identify the best first-line therapy for advanced lung cancer in patients with performance status 2 without a targetable mutation or with an unknown mutation status.

Preparation of highly activated natural killer cells for advanced lung cancer therapy.

Background: Natural killer (NK) cells can be used as an adoptive immunotherapy to treat cancer patients.Purpose: In this study, we evaluated the efficacy of highly activated NK (HANK) cell immunotherapy in patients with advanced lung cancer.Patients and methods: Between March 2016 and September 2017, we enrolled 13 patients who met the enrollment criteria. Donor peripheral blood monocytes were isolated from patients and the NK cells were expanded. After 12 days of culture, the cells were collected and infused intravenously on days 13 to 15. The enrolled patients received at least one course including three times of infusions. The lymphocyte subsets, cytokine production, and the expression of carcinoembryonic antigen (CEA) and thymidine kinase 1 (TK1) were measured before treatment and after the last infusion.Results: No side effects were observed. After a three-month follow-up, the percentage of patients who achieved stable disease and progressive disease was 84.6% and 15.4%. Moreover, the level of IFN-γ was significantly higher after treatment and the level of CEA decreased substantially. The overall immune function of the patients who received the NK cell therapy remained stable.Conclusion: This is the first study to describe the efficacy of NK cell therapy of patients with advanced lung cancer. These clinical observations demonstrated that NK cell is safe and efficient for advanced lung cancer therapy.

Pathological-anatomical diagnosis according to the German lung cancer guideline 2018

The German S3-guideline on prevention, diagnosis, therapy and follow-up of lung cancer, published in February 2018, expands on the 2010 guideline to include atotal of 19recommendations and statements regarding the "processing of lung resection specimens (tumor resection specimens)", "processing of lymph nodes", "histo-pathological typing and immunophenotype", "extent of tumor growth in resection specimens", "resection margins" or "R-classification", "grade of malignancy (grading)", "regression grading" as well as the "examination of molecular targets". The statements regarding the analysis of molecular targets result from the diagnostic requirements of the current targeted therapy of advanced lung cancer. At the same time, apathological-anatomical diagnosis according to the current S3-guideline fulfills all corresponding requirements in certified lung cancer centers.

New drugs in thoracic oncology: needs and knowledge - an online ERS Lung Cancer Assembly survey.

In the last decade, systemic therapy for advanced lung cancer has become diverse, complex and personalised. These new therapies (monoclonal antibodies, tyrosine kinase inhibitors (TKIs) and immunotherapy) have a far different toxicity profile compared to chemotherapy. Furthermore, clinical indications and reimbursement criteria can vary across Europe. The aim of the present online survey was to assess the knowledge, views and challenges facing the European respiratory community in this rapidly changing field.A 15-question web survey was sent to all European Respiratory Society members through the Society's monthly electronic communication.A total of 315 questionnaires were completed. Most of the respondents were male (59.1%), were above 40 years of age (52.9%) and were working in university/academic hospitals (74.8%), the majority as pulmonologists (90%). Only 55% of the participants were aware of the legal processes for drug recognition. Except for epidermal growth factor receptor TKI, up to 38% did not know about the specific toxicities of anaplastic lymphoma kinase/ROS proto-oncogene 1 TKIs, monoclonal antibodies and immune checkpoint inhibitors. Of the respondents, 92% showed an interest in an online platform reporting new drugs' toxicities.Despite a large amount of publicity and integration of new drugs into therapeutic algorithms and clinical guidelines, physicians taking care of lung cancer patients have a need for up-to-date information on systemic therapy toxicity management and legal constraints.

3A.01 Efficacy of Programmatic Combined Stereotactic Ablative Radiotherapy and Anti- PD-1 Therapy in Advanced Lung Cancer: A Retrospective Analysis: Topic: Medical Oncology

3A.01 Efficacy of Programmatic Combined Stereotactic Ablative Radiotherapy and Anti- PD-1 Therapy in Advanced Lung Cancer: A Retrospective Analysis: Topic: Medical Oncology

The technique of endoscopic airway tumor treatment.

More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions. Clinicians should select cases, evaluating tumor features (size, location) and patient characteristics (age, lung function impairment) to choose the most appropriate endoscopic technique. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement and local treatment of endobronchial lesions. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound (EBUS), autofluorescence bronchoscopy (AFB), and narrow band imaging (NBI). Other techniques, such as endobronchial intra-tumoral chemotherapy (EITC), EBUS-guided-transbronchial needle injection or bronchoscopy-guided radiofrequency ablation (RFA), are in development for the use within the airways. These endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer, benign or otherwise not approachable central airway lesions. We aimed at revising several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy (PDT).

Coronary artery bypass grafting after radiation therapy for lung cancer

Radiation therapy has been a common treatment modality for many malignant tumors, including lung cancer. Coronary artery disease can be an adverse effect of chest irradiation as well as other major coronary risk factors. Coronary artery bypass grafting in such patients is difficult due to the presence of extensive radiation-induced mediastinal fibrosis. Here, we describe a successful case of surgical treatment for left main of coronary artery occlusion after radiation therapy for advanced lung cancer.

PO-0876: Treatment adaptation is mandatory for intensity modulated proton therapy of advanced lung cancer

PO-0876: Treatment adaptation is mandatory for intensity modulated proton therapy of advanced lung cancer

Correlation between Classic Driver Oncogene Mutations in EGFR, ALK, or ROS1 and 22C3–PD-L1 ≥50% Expression in Lung Adenocarcinoma

IntroductionTargeted somatic genomic analysis (EGFR, anaplastic lymphoma receptor tyrosine kinase gene [ALK], and ROS1) and programmed death ligand 1 (PD-L1) tumor proportion score (TPS) determined by immunohistochemistry (IHC) are used for selection of first-line therapies in advanced lung cancer; however, the frequency of overlap of these biomarkers in routine clinical practice is poorly reported. MethodsWe retrospectively probed the first 71 pairs of patients with lung adenocarcinoma from our institution. They were analyzed for PD-L1 by IHC using the clone 22C3 pharmDx kit (Agilent Technologies, Santa Clara, CA) and evaluated for co-occurrence of genomic aberrations and clinicopathologic characteristics. ResultsSurgical resection specimens, small biopsy (transbronchial or core needle) samples, and cytologic cell blocks (needle aspirates or pleural fluid) were tested. A PD-L1 TPS of at least ≥50% was seen in 29.6% of tumors. Of 19 tumors with EGFR mutations, ALK fluorescence in situ hybridization positivity, or ROS1 fluorescence in situ hybridization positivity, 18 had a PD-L1 TPS less than 50% versus only one tumor with a PD-L1 TPS of at least 50% (p = 0.0073). Tumors with a PD-L1 TPS of at least 50% were significantly associated with smoking status compared with tumors with a PD-L1 TPS less than 50% but were not associated with patient sex, ethnicity, tumor stage, biopsy site, or biopsy type/preparation. ConclusionsPD-L1 IHC can be performed on routine clinical lung cancer specimens. A TPS of at least 50% seldom overlaps with presence of driver oncogenes with approved targeted therapies. Three biomarker-specified groups of advanced lung adenocarcinomas can now be defined, each paired with a specific palliative first-line systemic therapy of proven clinical benefit: (1) EGFR/ALK/ROS1-affected adenocarcinoma paired with a matched tyrosine kinase inhibitor (∼20% of cases), (2) PD-L1–enriched adenocarcinoma (TPS ≥50%) paired with anti–PD-1 pembrolizumab (∼30% of cases), and (3) biomarker-negative (i.e., EGFR/ALK/ROS1/PD-L1–negative) adenocarcinoma paired with platinum doublet chemotherapy with or without bevacizumab (∼50% of cases).

Adaptation is mandatory for intensity modulated proton therapy of advanced lung cancer to ensure target coverage

Background and purposeLarge anatomical changes during radiotherapy are seen for a large proportion of lung cancer patients. We investigate the applicability of a decision support protocol for photon therapy in a proton therapy setting. Material and methodsTwenty-three consecutive NSCLC patients treated with adaptive photon therapy were retrospectively planned using IMPT. The adaptive protocol was based on geometrical measures of target positioning and large anatomical changes as shown on daily CBCT scans. Two surveillance CT-scans were acquired during the treatment course. The consequences of anatomical changes were evaluated by recalculating the proton plans on the surveillance scans. The CTV receiving 95% of the prescribed dose was analysed. ResultsFourteen (61%) patients needed adaptations when treated with protons, given that 95% of the CTV must be covered by 95% of the dose. In comparison, no patients needed adaptation when treated with photons using this criterion. The adaptive protocol was found to identify patients with large target under-dosage for proton therapy (six patients). Additionally, target under-dosage was observed for eight patients with non-rigid changes up to 15mm in the positioning of the bones. ConclusionsProton therapy for loco-regional lung cancer demands daily imaging and therapy adaptation for a high proportion of patients.

Survival Benefit of Asian Females in the Era of Targeted Therapy for Advanced Lung Cancer: Metastatic Non-Small Cell Lung Cancer

Development of the EGFR tyrosine kinase inhibitors (TKIs) and FDA approval of erlotinib in 2004 began a decade of advances in targeted therapy for advanced lung cancer. Lung adenocarcinomas in Asian females are highly enriched for EGFR mutations. Despite randomized studies with improvements in progression free survival, TKIs have not yet proven to extend survival for patients harboring EGFR mutations. We sought to examine the survival advantage attributable to the use of TKIs, by comparing outcomes before and after the implementation of TKI therapy.

CP-673451, a platelet-derived growth-factor receptor inhibitor, suppresses lung cancer cell proliferation and migration.

Lung cancer is the leading cause of cancer mortality in the world. Although some advances in lung cancer therapy have been made, patient survival is still poor. The platelet-derived growth factor receptors (PDGFRs) and their ligands play critical roles in the regulation of many cancer cell processes, including cell survival and cell motility. Herein, we investigate the anticancer activities of CP-673451, a potent selective inhibitor of PDGFR kinase, in non-small-cell lung cancer (NSCLC) therapy. We found that CP-673451 is effective at suppressing cell viability, inducing cell apoptosis, and inhibiting cell migration and invasion by suppressing the PDGFR downstream signaling pathway in NSCLC cells. Furthermore, CP-673451 is effective at suppressing NSCLC tumor growth in vivo. In summary, our studies suggest that CP-673451 might be a promising therapeutic compound for NSCLC.

Survival benefit of Asian females in the era of targeted therapy for advanced lung cancer.

e17659 Background: Development of the EGFR tyrosine kinase inhibitors (TKI’s) and FDA approval of erlotinib in 2004 began a decade of advances in targeted therapy for advanced lung cancer. Lung ade...

Venovenous perfusion-induced systemic hyperthermia: Five-day sheep survival studies

Since hyperthermia selectively kills lung cancer cells, we developed a venovenous perfusion-induced systemic hyperthermia system for advanced lung cancer therapy. Our objective was to test the safety and accuracy of our venovenous perfusion-induced systemic hyperthermia system in 5-day sheep survival studies, following Good Laboratory Practice standards. Our venovenous perfusion-induced systemic hyperthermia system, which included a double-lumen cannula (Avalon Elite, Rancho Dominguez, Calif), a centrifugal pump (Bio-Pump 560; Medtronic Inc, Minneapolis, Minn), a heat exchanger (BIOtherm; Medtronic Perfusion Systems, Brooklyn Park, Minn), and a heater/cooler (modified Blanketrol IIIl Cincinnati Subzero, Cincinnati, Ohio), was tested in healthy adult sheep (n=5). The perfusion circuit was primed with prewarmed Plasma-Lyte A (Baxter Healthcare Corp, Deerfield, Ill) and de-aired. Calibrated temperature probes were placed in the right and left sides of the nasopharynx, bladder, and blood in/out tubing in the animal. The double-lumen cannula was inserted through the jugular vein into the superior vena cava, with the tip in the inferior vena cava. Therapeutic core temperature (42°C-42.5°C), calculated from the right and left sides of the nasopharynx and bladder temperatures, was achieved in all sheep. Heating time was 21±5 minutes. Therapeutic core temperature was maintained for 120 minutes followed by a cooling phase (35±6 minutes) to reach baseline temperature. All sheep recovered from anesthesia with spontaneous breathing within 4 hours. Arterial, pulmonary, and central venous pressures were stable. Transient increases in heart rate, cardiac output, and blood glucose occurred during hyperthermia but returned to normal range after venovenous perfusion-induced systemic hyperthermia termination. Electrolytes, complete blood counts, and metabolism enzymes were within normal to near normal range throughout the study. No significant venovenous perfusion-induced systemic hyperthermia-related hemolysis was observed. Neurologic assessment showed normal brain function all 5 days. Our venovenous perfusion-induced systemic hyperthermia system safely delivered the hyperthermia dose with no significant hyperthermia-related complications.

MiR-21: A Non-invasive Biomarker and Potential Therapeutic Target for Lung Cancer?

We read with great interest the article, published in Cell Biochem Biophys, showing that serum level of miR-21 was significantly elevated in lung cancer patients compared with controls. Receiver operating characteristic (ROC) curve analysis showed that miR-21 could differentiate lung cancer from healthy controls with an AUC (the area under the curve) of 0.85, and the optimal sensitivity and specificity were 85.7 and 86.5 %, respectively [1]. These findings suggest that miR-21 can be a potential non-invasive biomarker for lung cancer patients and miR-21 may be a potential therapeutic target for lung cancer. Lung cancer is one of the most common malignant tumors and is the leading cause of cancer mortality in the world [2]. Non-small cell lung cancer (NSCLC) accounts for approximately 80–85 % of all cases of lung cancer [3]. Despite much advances in lung cancer therapy, the survival rate for lung cancer patients remains very poor [4]. Recent advances in functional genomics provide an increasingly comprehensive portrayal of lung tumorigenesis, but the molecular pathogenesis of lung cancer remains poorly understood. These findings highlight the need for a better understanding of novel molecular mechanisms to guide treatment of lung cancer. MicroRNAs (miRNAs) are small non-coding RNAs that repress target gene expression by a combination of mRNA degradation and translation inhibition [5]. Recently, miR-21 expression was found to be higher in lung cancer serum samples than in control serum samples [3, 6–9]. High serum miR-21 was significantly correlated with tumor node metastases stage and lymph node metastasis of NSCLC patients [3, 5]. Overexpression of miR-21 showed a highly discriminative ROC curve profile, clearly distinguishing cancer patients from cancer-free subjects, and the detection of miR-21 expression yielded high sensitivity and specificity in the diagnosis of lung cancer [7–9]. Furthermore, miR-21 expression was elevated in human lung cancer cell lines (NCI-H446 and NCI-H460) [2]. Human mutS homolog 2 (hMSH2), one of the core mismatch repair genes, is affected in lung cancer development. Zhong et al. [2] found that hMSH2 was directly regulated by miR-21, and miR-21 expression was inversely correlated with hMSH2 expression in human lung cancer cell lines [2]. Notably, upregulation of miR-21 markedly promoted cell proliferation and revealed a higher proportion of cells at S phase. However, knockdown of miR-21 expression led to cell cycle arrest at G2/M phase and inhibited cell proliferation [2]. Similarly, tumor tissues showed an inverse correlation between high expression of miR-21 and low amounts of PTEN protein, where miR-21 suppresses PTEN by direct binding to the 30-UTR of PTEN [5]. Lung cancer cell lines (A549, H1703, and 801D) transfected with miR-21 inhibitor showed decreased endogenous miR-21 levels but significantly increased PTEN protein expression [5]. In addition, A549 and H1703 cells transfected with miR-21 inhibitor could restrain the growth of A549 and H1703 cells, and downregulation of miR-21 with miR-21 inhibitor in 801D cells could restrain its invasion ability [5]. Collectively, available evidence suggests that miR-21 may be a good biomarker for detection of lung cancer, and miR-21 may play an important role in lung cancer. However, further studies, especially in human systems, are needed to comprehensively explore the role of miR-21 in lung cancer, and miR-21 may be a potential therapeutic target for lung cancer. S.-C. Wang (&) Y.-F. Zhang Q. Xie PET/CT Center, Anhui Provincial Hospital, 17 Lujiang Road, Hefei 230001, Anhui, People’s Republic of China e-mail: wangsc3329@163.com

State of the Art: Response Assessment in Lung Cancer in the Era of Genomic Medicine

Tumor response assessment has been a foundation for advances in cancer therapy. Recent discoveries of effective targeted therapy for specific genomic abnormalities in lung cancer and their clinical application have brought revolutionary advances in lung cancer therapy and transformed the oncologist's approach to patients with lung cancer. Because imaging is a major method of response assessment in lung cancer both in clinical trials and practice, radiologists must understand the genomic alterations in lung cancer and the rapidly evolving therapeutic approaches to effectively communicate with oncology colleagues and maintain the key role in lung cancer care. This article describes the origin and importance of tumor response assessment, presents the recent genomic discoveries in lung cancer and therapies directed against these genomic changes, and describes how these discoveries affect the radiology community. The authors then summarize the conventional Response Evaluation Criteria in Solid Tumors and World Health Organization guidelines, which continue to be the major determinants of trial endpoints, and describe their limitations particularly in an era of genomic-based therapy. More advanced imaging techniques for lung cancer response assessment are presented, including computed tomography tumor volume and perfusion, dynamic contrast material-enhanced and diffusion-weighted magnetic resonance imaging, and positron emission tomography with fluorine 18 fluorodeoxyglucose and novel tracers. State-of-art knowledge of lung cancer biology, treatment, and imaging will help the radiology community to remain effective contributors to the personalized care of lung cancer patients.

Anti-Cancer Therapy of Advanced Lung Cancer in Elderly Patients

Lung cancer is not only the most common cancer of the elderly but is also the leading cause of cancer related mortality in Korea. Therefore, the elderly form a large subgroup of patients with advanced lung cancer. Aging is associated with co-morbidities, poor performance status, and impaired organ function. These problems can cause uncertainty when selecting the optimal treatment for advanced lung cancer, and some elderly patients could be undertreated. Patients with non-squamous histology lung cancer, regardless of age or performance status, should be tested for epidermal growth factor receptor (EGFR) mutations; patients with EGFR mutations such as del 19 or L858R are able to receive EGFR tyrosine kinase inhibitors. The treatment options for elderly patients with lung cancer include best supportive care, single agent chemotherapy, platinum-based doublet chemotherapy, and targeted therapy. The optimum therapeutic option for elderly individuals with advanced lung cancer must be selected carefully, taking into account both the risks and benefits. (Korean J Med 2014;87:537-541)