Characterization and management of elderly and very elderly patients with non‐small cell lung cancer

Abstract

ObjectivesDespite non‐small cell lung cancer (NSCLC) high prevalence and increasing incidence, evidence specific to the elderly and very elderly is sparse. To retrospectively compare characterization and approach of NSCLC patients (pts) aged 70‐79 and ≥80 years.MethodsWe performed a retrospective analysis of 297 adult NSCLC pts who registered and initiated NSCLC management in our Pulmonology Oncology Unit from January 2013 to December 2016 corresponding to 38.2% of all NSCLC patients (n = 778). Demographic data and lung cancer management were analysed.ResultsPts were categorized as elderly (n = 211, 71.0%) and very elderly (n = 86, 29.0%). Very elderly pts had worse Eastern Cooperative Oncology Group performance status (P = 0.047), higher Charlson age comorbidity index (P < 0.001) and the majority had stage IV cancer (66.3%, P = 0.04). The first management option in very elderly pts was chemotherapy (CTX) (30.2%, P = 0.37) and in elderly pts was multimodal therapy (30.3%, P ≤ 0.001). Support therapy and first‐line targeted (EGFR or ALK‐positive) were more common in the very elderly (23.6%, P = 0.01; 17.4% P = 0.002, respectively). Curative radiation or surgery rates did not differ between groups. Reasons for premature first‐line CTX stop, toxicity and hospitalization did not differ. Death rate (69.7% vs 63.5% for very elderly and elderly, respectively) and mean survival since diagnosis (11.5 vs 11.6 months for very elderly and elderly, respectively) did not differ.ConclusionsThere were significant differences in pts characteristics having the very elderly more multimorbidity and advanced state of disease. First management options were significantly different with respect to multimodal, targeted and support therapy.

Construction and validation of prognostic nomograms for elderly patients with metastatic non‐small cell lung cancer

“…The previous studies reported that patients with NSCLC diagnosed at the age over 80 years contributed to worse LCSS and OS, 26,27 which were consist with our investigation. Worse nutritional status, reduced physiological reserve, basic diseases and poor tolerance to cancer treatment in the older group might be explanations 28,29 . Approximately 30%–40% of patients with NSCLC develop metastases at initial diagnosis 30 .…”

“…Worse nutritional status, reduced physiological reserve, basic diseases and poor tolerance to cancer treatment in the older group might be explanations. 28 , 29 Approximately 30%–40% of patients with NSCLC develop metastases at initial diagnosis. 30 Nevertheless, there is still controversy regarding the influences of metastatic site of lung cancer on prognosis.…”

Effectiveness and Safety of PD-1 Inhibitor Monotherapy for Elderly Patients with Advanced Non-Small Cell Lung Cancer: A Real-World Exploratory Study

“…As a result, elderly patients were usually excluded from most of the clinical trials, resulting in limited clinical evidence available for elderly patients with NSCLC in clinical practice [26]. Consequently, a large number of elderly patients with advanced NSCLC were in need of the efficacious and tolerable therapeutic options in clinical practice urgently to further prolong their survival [27].…”

Efficacy and safety of Nivolumab in older patients with pretreated lung cancer: A subgroup analysis of the Galician lung cancer group

“…Favorable results in terms of PFS (4.5 months, CI 3.0-5.8) and OS (16 months, CI 12.1-19.8) were observed, with an ORR of 27.4% and achieving good rates of CR (5.3%), partial responses (22.1%) and low toxicity levels (27% of patients discontinued treatment due to any grade AE). Recently, a retrospective trial of 297 NSCLC raised an interesting study design, recording patients as elderly (between 70 and 80 years) and very elderly (≥80 years) [24]. The very elderly population group presented with poorer PS (p = 0.047), with a higher burden of comorbidities, less social support, and increased mortality.…”