Half of all patients diagnosed with non-small cell lung cancer are 70 years of age or older, yet despite this high percentage, these elderly patients are not well represented in clinical trials. Therefore, the paucity of clinical data has made it difficult to reach evidence based clinical recommendations.
In 2010, the EORTC Cancer in the Elderly Task Force and Lung Cancer Group along with the International Society for Geriatric Oncology (SIOG) wrote an expert opinion on managing treatment for elderly patients with non-small cell lung cancer (NSCLC), and now, in an article appearing in the Annals of Oncology, they have updated their expert opinion. This update includes recommendations for screening, surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease as well as new data on patient preferences and geriatric assessment.
Dr. Mary O`Brien, Royal Marsden Hospital, UK, and Chair of the EORTC Lung Cancer Group advises, "Treatment decisions for elderly patients with NSCLC should not be based on their chronological age alone; there are many other factors that need to be considered. For instance, what is the patient's life expectancy and preferences? What are the expected benefits and risks of the treatment?"
Dr. Ulrich Wedding, Universitaetsklinikum, Jena, Germany, Chair of the SIOG Publications Committee, and Treasurer of the EORTC Cancer in the Elderly Task Force adds, "People do not all age the same, so we also need to consider their biological or functional age when deciding on treatment. Multidimensional, multidisciplinary, comprehensive geriatric assessment can lead to better treatment for elderly patients with NSCLC."
Several prospective clinical studies concerning both locally advanced and metastatic disease lend support to the feasibility of age-specific clinical trials and provide reliable data, as well, that can be used to guide treatment decisions. The EORTC and SIOG researchers advocate that more effort should be made to develop such studies in other disease stages, and efforts should also be made to include patients more representative of the general elderly population, not just very fit patients.