Navigating the Challenges of Adjuvant Chemotherapy in Older Patients with Early-Stage Non-Small-Cell Lung Cancer

Lung cancer is a disease of older adults. In the US and worldwide, more than 60 % of patients being diagnosed are over the age of 65 years. The preferred treatment of stage I–II non-small-cell lung cancer (NSCLC) is surgical resection. Adjuvant chemotherapy with a platinum-based combination is the standard of care for patients with early-stage NSCLC after surgery. However, there have been no large prospective studies to test the efficacy of adjuvant chemotherapy in the elderly, the population most affected by lung cancer. The available evidence is limited to retrospective reviews of large population databases or post hoc analyses of prospective studies in age-unselected populations. This review aims to address the knowledge gap pertaining to the use of adjuvant chemotherapy in older patients with resected NSCLC. There are many barriers to use of adjuvant chemotherapy in older adults with NSCLC. The utilization of adjuvant chemotherapy amongst older adults has been slow but is improving. While the elderly may tolerate a lower dose intensity of chemotherapy compared with younger patients, they do garner benefit from adjuvant chemotherapy. There is a lack of a standardized tool to risk-stratify older patients for adjuvant chemotherapy after resection. Geriatric assessment may help guide decision making in the clinical practice setting. The principles of geriatric assessment and commonly employed tools for such assessment will be reviewed. Further, the emerging therapies in adjuvant treatment of lung cancer based on genetic mutations will be discussed.