Treatment of lung cancer in the elderly

Lee, Jeong Eun; Kim, Sun Young

Abstract

Elderly patients frequently experience progressive decline of organ function and multiple comorbidities, which need to be considered when choosing therapy. In early non-small cell lung cancer (NSCLC), surgical resection is the mainstay of curative treatment with a favorable survival even in the elderly. But postoperative mortality following pneumonectomy is high, and this operation should only be performed in selected patients with acceptable heart-lung function. In locally advanced NSCLC, combined chemoradiotherapy is effective in younger patients and in older patients, despite increased toxicity. Platinum based combination chemotherapy is similar in fit older and younger patients with increased but acceptable toxicity for elderly patients. Single agent chemotherapy with a third generation agent (gemcitabine, vinorelbine, taxanes) could be considered a reasonable treatment option for elderly patients. Target therapy with pemetrexed, gefitinib and erlotinib is feasible to treat elderly patients. In limited disease small cell lung cancer (SCLC), concurrent chemoradiotherapy seem to be superior to sequential approach and yield higher survival despite increased toxicity. In case of elderly patients, it is not supported by prospective trials. Prophylactic cranial irradiation is the standard treatment in limited disease SCLC except patients with cognitive dysfunction. In extensive disease SCLC, platinum based chemotherapy is standard treatment. Many studies demonstrate that the elderly patient with a good performance status (PS) can tolerate chemotherapy that has similar toxicity and benefits as nonelderly patients. But, the assessment of comorbidity and the evaluation of functional status are prerequisite for benefit in elderly patients. It can be useful, not only for providing important information to the patients, but also for the correct choice of treatment.