ABSTRACT
Introduction
Lung cancer is the most common cancer diagnosed worldwide. Data from several studies fall short to make appropriate conclusions on the management for elderly patients. The discovery of targeted therapy and immunotherapy has allowed these patients access to a wider array of options.
Areas covered
The authors review research for treating older patients with lung cancer focusing on research performed in this patient population. Data are presented relating to chemotherapy, immunotherapy, and targeted therapy in the advanced setting.
Expert opinion
Elderly patients particularly benefit from advances in systemic therapy. Based on the tumor profile, treatment with targeted therapy or immunotherapy should be favored over chemotherapy where possible in the elderly population. Elderly patients benefit from EGFR, ALK, and ROS-1 inhibition in the setting of these tumor alterations. These agents should be utilized early in the treatment course. Across many studies, the benefit from immunotherapy is seen irrespective of age. Favorable outcomes and toxicity profiles from immunotherapy compared to chemotherapy are well described. Chemotherapy should be offered with caution after a detailed assessment. Options include combination or single-agent chemotherapy regimens. Best supportive care alone is a reasonable option in the frailer, highly co-morbid patient.
Article highlights
Elderly patients are poorly represented in older drug-based clinical trials
Age alone should not be the only factor in determining fitness for therapy – performance status, co-morbidities, patient wishes, and appropriate tumor profiling should all inform treatment decisions
A comprehensive geriatric assessment is a useful tool in determining fitness for therapy
Targeted therapy and immunotherapy should be favored where relevant as evidence suggests superior outcomes and toxicity profiles in the elderly cohort
Various chemotherapy strategies can be considered however should be tailored to the clinical scenario
More focused elderly (≥75 years) clinical trials are required
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Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
One referee declares that his institution receives research support from Bristol-Myers Squibb, Merck & Co, Genentech/Roche, Pfizer and Novartis. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.