Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Jul 28, 2015; 5(2): 102-111
Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.102
Advanced non-small cell lung cancer in elderly patients: A review
Lucio Buffoni, Lorena Consito, Andrea Riccardo Filippi, Enrico Ruffini, Paolo Solidoro, Paolo Bironzo, Maria Antonietta Satolli, Marina Schena, Libero Ciuffreda
Lucio Buffoni, Lorena Consito, Paolo Bironzo, Marina Schena, Libero Ciuffreda, Department of Medical Oncology, San Giovanni Battista Molinette Hospital, 10126 Turin, Italy
Andrea Riccardo Filippi, Department of Oncology, Radiation Oncology, University of Turin, 10124 Turin, Italy
Enrico Ruffini, Department of Thoracic Surgery, School of Medicine, University of Turin, 10124 Turin, Italy
Paolo Solidoro, Division of Pulmonology, University of Turin, 10124 Turin, Italy
Maria Antonietta Satolli, Department of Oncology, University of Turin, 10124 Turin, Italy
Author contributions: Being a review article authors contributed to conception and design of the review, acquisition of data, and analysis and interpretation of data; drafting the article and final approval of the version of the article to be published.
Conflict-of-interest statement: The authors disclosed any conflict of interest with the material included in the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lucio Buffoni, MD, Department of Medical Oncology, San Giovanni Battista Molinette Hospital, 15, Via Cherasco, 10126 Turin, Italy. buffonil75@gmail.com
Telephone: +39-11-6335189 Fax: +39-11-6335189
Received: September 24, 2014
Peer-review started: September 26, 2014
First decision: December 17, 2014
Revised: March 3, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: July 28, 2015
Processing time: 313 Days and 20.7 Hours
Abstract

Over 50% of patients diagnosed with non-small-cell lung cancer (NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.

Keywords: Lung cancer, Elderly, Chemotherapy, Target therapy

Core tip: Due to progressive ageing of population in the next few years a consistent proportion of non-small-cell lung cancer (NSCLC) patients will be diagnosed over the age of 70 years old. Guide lines indications together with results from most recent phase III trials dedicated to elderly patients are discussed along the review. Special attention has been deserved to toxicity profile. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials as for more accurate evaluation with increasing evidence for a comprehensive geriatric assessment as a valid tool for treatment selection in NSCLC elderly patients.