The 800-lb gorilla we all ignore: treatment of NSCLC in elderly and PS 2 patients

Abstract

Patients with non-small cell lung cancer,NSCLC, typically have advanced disease on presentation. First-line palliative platinum-based doublet chemotherapy has emerged as the standard of care in fit, younger patients. However, patients with advanced age and/or impaired performance status have been relatively underrepresented in clinical trials. Retrospective analyses and the few existing prospective randomized trials in these populations have suggested a poorer overall prognosis, yet also provide evidence of benefit from systemic therapy. Toxicity is generally manageable, and in most cases, comparable to that of younger, healthier patients. There are clearly expanding roles for nonplatinum chemotherapy agents and newer targeted therapies, which have generally yielded decreased toxicity compared to platinum-based chemotherapy without sacrificing efficacy. Appropriate pretreatment assessment and proper patient selection is of paramount importance; it is imperative to treat patients who are most likely to garner benefit. In summary, data suggest that these relatively neglected populations of NSCLC patients can be safely treated, and can benefit from palliative systemic therapy. Single-agent chemotherapy is generally recommended over combination chemotherapy, although investigation of newer targeted therapies or alternative agents may allow for combination therapy in the near future. Further prospective investigation is absolutely warranted.