Current status of chemotherapy use and clinical outcome in octogenarians with advanced non-small cell lung cancer

Although about one-fourth of patients dying of lung cancer are aged 80 years or older in Korea, the current treatment status and outcome in octogenarians are largely unknown. We aimed to evaluate the proportion of octogenarians with advanced non-small cell lung cancer (NSCLC) who receive systemic chemotherapy and analyze the clinical outcome in these patients.

The medical records of 281 octogenarians who were diagnosed with stage IIIB/IV or recurrent NSCLC were retrospectively reviewed.

In total, 127 out of 281 patients (45 %) received chemotherapy. Among the patients with ECOG PS 0-2, 119 patients (57 %) received chemotherapy. The first-line treatments were platinum doublets in 61 patients (48 %), single-agent chemotherapy in 34 (27 %), and epidermal growth factor receptor tyrosine kinase inhibitors in 32 (25 %). In patients with ECOG PS 0-2, patients who received chemotherapy lived longer compared with patients who only received best supportive care (16.1 vs. 4.0 months, P < 0.001). Among the 127 patients who received chemotherapy, patients who received EGFR TKIs showed longer survival than patients who only received cytotoxic agents (21.4 vs. 9.8 months, P < 0.001). In a multivariate analysis, ECOG PS 3-4 and smoking history were unfavorable prognostic factors, while recurrent disease and systemic chemotherapy were favorable prognostic factors.

Nearly half of octogenarians with advanced NSCLC received systemic chemotherapy. The patients showed prolonged survival compared with the best supportive care group. Further studies are warranted to provide an optimal tailored treatment for octogenarians.