Older age, poor performance status and major comorbidities

Abstract

Purpose of review Lung cancer is the leading cause of mortality in men and women, and the majority of patients with nonsmall cell lung cancer (NSCLC) are over 65 years of age. Treatment of elderly patients with NSCLC poses a significant therapeutic challenge owing to numerous pre-existing comorbidities, often- poor performance status and the increased risk of chemotherapy toxicities. Recent findings Single-agent chemotherapy is well tolerated, leads to an improvement in survival and quality of life outcomes and is favored by many clinicians in the treatment of elderly patients with NSCLC. Results from recent elderly specific randomized phase III trials and retrospective subgroup analyses of several trials have evaluated the use of combination chemotherapy in this difficult subgroup of patients, with encouraging results. Summary Elderly patients derive significant benefit from combination cytotoxic chemotherapy over single-agent chemotherapy. Therapeutic options for elderly patients include chemotherapy and/or targeted therapy, based on the individual tumor histology and molecular profile. As our population ages, it is critical we develop treatment strategies that are well tolerated, and which both minimize toxicity and maximize efficacy.