Diagnostic and therapeutic strategies for elderly patients with advanced non-small cell lung cancer (NSCLC): Results from an EORTC pan-European survey

Abstract

Background: The EORTC Lung Cancer Group (LCG) and the Elderly Task Force (ETF) developed a pan-european survey that aims to provide an overview of the management and treatment strategies for elderly patients (pts) diagnosed with advanced NSCLC, as well as to identify potential needs and scientific pending questions that could be addressed in new trials. Methods: An electronic 13-topic survey explaining the study purpose was developed and sent to all EORTC LCG and ETF members. The 25-items included multiple-choice and open-ended questions requesting the following information on general demographics (6 items), pts population (3 items) and diagnostic, treatment preferences and outcomes (4 items). Elderly pts were defined as those older than 70 years. Results: Sixty-two individual sites, from19 countries, completed the online questionnaire. In 42 centers (67.7%) there is no dedicated teamfor the management and treatment of elderly pts; on the other hand, only in 2 centers (3.2%) pts with suspected NSCLC are not discussed by a multidisciplinary board. Notably, oncogeriatric assessment is routinely performed in 17 (27.4%) centers;G8, CGA or both scales are the preferred evaluation tools (35.3%, 23.6%and 11.8% respectively). In fit pts, the preferred first-line chemotherapy regimens are Carboplatin (CBDCA)-Pemetrexed (PEM) 19 (31.7%), CBDCA-Paclitaxel (PAC) 15 (24.2%), Cisplatin (CDDP)-PEM14 (22.6%), CBDCA-Gemcitabine (GEM) 10 (16%), other 3 (4.8%). In the second line setting the preferred treatments areNivolumab 30 (45.5%), PEM11 (16.7%), Docetaxel 9 (13.6%), PAC 8 (12.1%), GEM4 (6.1%), Erlotinib 4 (6.1%); while PEM15 (24.2%), Nivolumab 13 (20.1%), PAC 9 (14.5%), Docetaxel 6 (9.7%), GEM6 (9.7%), other 11 (17.7%) represent a second level option. Conclusions: The survey provides an overview of the clinical practice in the management of elderly patients with advanced NSCLC, summarizing relevant and updated background for the possible development of future collaborative trials. In this survey, different treatment regimens are used by different centers, and geriatric assessment is used heterogeneously, reflecting the lack of a "standardized" approach and the need for further research in this area.