Chemotherapy of non-small cell lung cancer in the elderly

Around one-third of all patients with non-small cell lung cancer (NSCLC) are over the age of 70. Elderly patients tolerate chemotherapy poorly because of impaired organ function and co-morbidities. For this reason, these patients are often not considered eligible for aggressive cisplatin-based chemotherapy. A multidimensional geriatric evaluation is important to plan appropriate treatments. At present, there are no indications for adjuvant and neoadjuvant chemotherapy. Combined chemo-radiotherapy in locally advanced disease increases toxicity and seems determine no survival advantage as compared to radiation therapy alone. In advanced disease, single agent vinorelbine proves to be active and well-tolerated, and compared to best supportive care, improves survival and perhaps quality of life. Gemcitabine is active and well tolerated as well. Taxanes are in advanced phase of evaluation. A phase III randomized trial showed that polychemotherapy with gemcitabine + vinorelbine does not improve any outcome as compared to single agent chemotherapy with vinorelbine or gemcitabine. In clinical practice, single agent chemotherapy should remain the standard treatment. The choice of the drug should be based on the toxicity profile of each drug and type of co-morbid conditions. In the near future, new therapeutic strategies and biological agents could improve present results.