Experts weigh in on managing elderly patients with NSCLC

Approximately half of all patients with a diagnosis of non-small cell lung cancer (NSCLC) are age 70 years or older, yet despite this high percentage, elderly patients are not well represented in clinical trials. Therefore, the paucity of clinical data has made it difficult to reach evidence based clinical recommendations.

In 2010, the European Organization for Research and Treatment of Cancer (EORTC) Cancer in the Elderly Task Force and Lung Cancer Group along with the International Society for Geriatric Oncology (SIOG) wrote an expert opinion paper on managing elderly patients with NSCLC.

Now, in an article appearing in the Annals of Oncology (2014; doi:10.1093/annonc/mdu022), they have updated their expert opinion. This update includes recommendations for screening, surgery, adjuvant chemotherapy, radiotherapy, and treatment of locally advanced and metastatic disease, as well as new data on screening patient preferences and geriatric assessment.

“Treatment decisions for elderly patients with NSCLC should not be based on their chronologic age alone; there are many other factors that need to be considered. For instance, what is the patient's life expectancy and preferences? What are the expected benefits and risks of the treatment?” advised Mary O`Brien, MD, FRCP, of Royal Marsden Hospital, in Sutton, Surrey, United Kingdom, and Chair of the EORTC Lung Cancer Group.

“People do not all age the same, so we also need to consider their biological or functional age when deciding on treatment. Multidimensional, multidisciplinary, comprehensive geriatric assessment could lead to better treatment for elderly patients with NSCLC,” added Ulrich Wedding, MD, PhD, Universitaetsklinikum, Jena, Germany, Chair of the SIOG Publications Committee, and Treasurer of the EORTC Cancer in the Elderly Task Force.

Several prospective clinical studies concerning both locally advanced and metastatic disease lend support to the feasibility of age-specific clinical trials and provide reliable data that can be used to guide treatment decisions. The EORTC and SIOG researchers advocate that more effort should be made to develop such studies in other disease stages, and efforts should also be made to include patients more representative of the general elderly population, not just very fit patients.

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