Epidermal growth factor receptor tyrosine kinase inhibitors in elderly patients with non-small cell lung cancer

Abstract

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. At diagnosis, half of the patients are over 70 years of age, and most present with advanced disease, for which chemotherapy is recommended as first-line treatment. However, the benefit from such therapy is modest and it is at times poorly tolerated. The discovery of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has significantly impacted the treatment of patients with EGFR mutation-positive advanced NSCLC. These novel agents demonstrate efficacy and a favorably mild toxicity profile. Despite limited data in elderly patients, the largest subpopulation in NSCLC, EGFR-TKIs are considered the standard of care therapy for advanced EGFR-positive disease in the elderly. In this review, we seek to compile the available data about the EGFR-TKIs use in elderly patients with advanced NSCLC, with the hope to better understand its role in this major yet, underrepresented, group of patients.

Keywords:

• afatinib
• EGFR-TKIs
• elderly
• erlotinib
• gefitinib
• non-small cell lung cancer

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Non-small cell lung cancer (NSCLC) is a disease of the elderly, however, this subpopulation is underrepresented and undertreated.

• Traditional first-line treatment for patients with advanced NSCLC remains platinum-based chemotherapy, with a modest benefit and significant toxicity.

• Epidermal growth factor receptor tyrosine kinase inhibitors are a successful therapeutic modality in the management of advanced epidermal growth factor receptor mutation-positive NSCLC, yielding prolonged progression-free survival and reduced toxicities.

• Gefitinib is a good therapeutic option for elderly patients with advanced epidermal growth factor receptor mutation-positive NSCLC, both as first- and subsequent-lines of therapy.

• Erlotinib is an effective and well-tolerated first-line treatment option for advanced disease in mutation selected elderly patients. It is also a reasonable option for the second- or subsequent line of treatment in these patients.

• Unlike first-generation epidermal growth factor receptor tyrosine kinase inhibitors, no single study was conducted to look at afatinib use in the elderly population. However, results from subgroup analysis are promising.

• Physicians have many aspects to consider when initiating treatment with epidermal growth factor receptor tyrosine kinase inhibitors for elderly patients with advanced NSCLC, including the patient’s life expectancy, performance status, co-morbidities, cost, and most importantly their preferences prior to initiation of therapy.

• Chronological age should not be the basis of treatment decisions in elderly patients with NSCLC.