Chemotherapy of advanced non-small cell lung cancer in elderly patients

Non-small cell lung cancer (NSCLC) is the leading cause of related cancer mortality worldwide and it may be considered typical of advanced age. Since most patients with NSCLC are at an advanced stage of the disease at diagnosis, chemotherapy is the mainstay of treatment. Elderly patients tolerate chemotherapy poorly compared to their younger counterparts because of their progressive reduction of organ function and age-related comorbidities. This is why these patients are often not considered eligible for aggressive platinum-based chemotherapy, the standard of care for advanced NSCLC. To date, in clinical practice, single-agent chemotherapy with a third-generation drug should be the recommended option for non-selected elderly patients with advanced NSCLC. However, feasibility of platinum-based chemotherapy remains an open issue and has to be proven in prospective randomized trials. High priority should also be given to the evaluation of the role of new molecular targeted therapies. Several novel biologic agents are at various stages of clinical development in advanced NSCLC with some of them reporting improvements in several outcomes. Their potential better tolerability renders them attractive alternatives in the treatment of this subgroup of patients. Moreover, a comprehensive geriatric assessment for individualized treatment choice in NSCLC elderly patients is mandatory.