Annals of Oncology Advance Access published online on August 28, 2009
Annals of Oncology, doi:10.1093/annonc/mdp360
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EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts’ opinion for the treatment of non-small-cell lung cancer in an elderly population
1 EORTC Headquarters, EORTC-ETF, Brussels, Belgium
2 Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
3 Department of Respiratory Medicine & Thoracic Oncology, Ghent University Hospital, Gent, Belgium
4 EORTC Lung Cancer Group, Brussels, Belgium
5 Department of Thoracic Oncology, Assistance Publique—Hôpitaux de Marseille, Faculté de Médecine, Université de la Méditerranée, Marseille, France
6 Department of Hematology, Oncology, Palliative Care, University Hospital Jena, Jena, Germany
7 EORTC Headquarters, EORTC Lung Cancer Group, Brussels, Belgium
8 Department of Medicine, Penn State Cancer Hershey Institute, Hershey, USA
9 IMO Clinique de Genolier, Genolier, Switzerland
* Correspondence to: Dr A. G. Pallis, EORTC Headquarters, EORTC-ETF, Avenue E.Mounierlaan, 83/11, B-1200 Brussels, Belgium. Tel: +32-(0)2-774-10-62; Fax: +32-(0)2-774-35-45; E-mail: athanasios.pallis{at}eortc.be
Non-small-cell lung cancer (NSCLC) represents a common health issue in the elderly population. Nevertheless, the paucity of large, well-conducted prospective trials makes it difficult to provide evidence-based clinical recommendations for these patients. The present paper reviews the currently available evidence regarding treatment of all stages of NSCLC in elderly patients. Surgery remains the standard for early-stage disease, though pneumonectomy is associated with higher incidence of postoperative mortality in elderly patients. Given the lack of demonstrated benefit for the use of adjuvant radiotherapy, it is also not recommended in elderly patients. Elderly patients seem to derive the same benefit from adjuvant chemotherapy as younger patients do, with no significant increase in toxicity. For locally advanced NSCLC, concurrent chemoradiotherapy may be offered to selected elderly patients as there is a higher risk for toxicity reported in the elderly population. Third-generation single-agent treatment is considered the standard of care for patients with advanced/metastatic disease. Platinum-based combination chemotherapy needs to be evaluated in prospective trials. Unfortunately, with the exception of advanced/metastatic NSCLC, prospective elderly-specific NSCLC trials are lacking and the majority of recommendations made are based on retrospective data, which might suffer from selection bias. Prospective elderly-specific trials are needed.
age, elderly, experts’ opinion, EORTC, lung cancer, NSCLC, SIOG