Lung cancer in older adults: Systemic treatment

Abstract

Lung cancer is the first cause of death by cancer throughout the entire world. Its incidence increases with age, and thus median age at diagnosis is 70 years in the USA. As in younger counterparts, non-small-cell lung cancer represents 85% of the cases, but squamous cell carcinoma is more frequent than in younger patients. Diagnosis is often performed at an advanced stage, and thus systemic treatment is frequently to be discussed. It is only last two decades that clinical trials devoted to elderly patients have been conducted, and until recently, treatment was often suboptimal, with poor results which contributed to nihilistic attitudes among patients, relatives, and doctors. Regarding small cell lung cancer, the doublet carboplatin-etoposide is the most frequently used in elderly patients. For non-smallcell lung cancer, targeted therapies should be used in those patients with EGFR or V600E BRAF mutations and ALK or ROS1 translocations whatever the performance status (PS). For patients without targetable mutations, carboplatin-based doublet can be used as frontline therapy in patients with PS 0-2. Regarding second-line therapy, the most frequently studied in elderly patients has been erlotinib. The role of checkpoint inhibitors in elderly patients is still not well established as the only data we have are subgroup analyses of phase III randomized trials with no age upper limit and with no specific clinical trials.