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Published on: September 8, 2023
Targeted therapy for older patients with an oncogene driven non-small cell lung cancer: Recommendations from a SIOG
L Decoster1, D R Camidge2, J A Fletcher3
1Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Medical Oncology, Translational Oncology Research Center (TORC), Team Laboratory for Medical and Molecular Oncology (LMMO), Laarbeeklaan 101 1090 Brussels, Belgium.
Abstract:
Lung cancer is mostly a disease of aging with approximately half of newly diagnosed patients being 70 years or older. Treatment decisions in this population pose unique challenges because of their heterogeneity with regards to daily functioning, cognition, organ function, comorbidities and polypharmacy, their underrepresentation in clinical trials and the impact of treatment on patient-centered outcomes, particularly in frail patients. The advent of targeted therapies and immunotherapy has revolutionized the management of advanced non-small cell lung cancer (NSCLC). Molecular profiling has allowed for the identification of actionable genomic alterations and targeted therapies have become standard of care for oncogene-driven NSCLC, significantly improving prognosis and quality of life. However, the data on the efficacy and tolerability of these treatments in older patients remain sparse. This review, conducted by the International Society of Geriatric Oncology (SIOG) NSCLC task force, examines the available literature on the use of targeted therapies in patients aged 70 years or older with oncogene-driven NSCLC. The task force's expert recommendations aim to guide treatment decisions for older patients with oncogene driven NSCLC.
Insights
Older adults (70+) with advanced non-small cell lung cancer (NSCLC) benefit from targeted therapies, but data are limited. This review provides expert recommendations for treating this population with oncogene-driven NSCLC.
Area of Science:
- Geriatric Oncology
- Thoracic Oncology
- Pharmacogenomics
Background:
- Lung cancer disproportionately affects older adults (≥70 years).
- Treatment decisions for elderly patients are complex due to heterogeneity and underrepresentation in clinical trials.
- Targeted therapies have transformed advanced non-small cell lung cancer (NSCLC) management.
Purpose of the Study:
- To review the efficacy and tolerability of targeted therapies in older adults (≥70 years) with oncogene-driven NSCLC.
- To provide expert recommendations for the treatment of this specific patient population.
- To address the sparse data on geriatric populations in clinical trials for NSCLC.
Main Methods:
- Systematic literature review on targeted therapies for oncogene-driven NSCLC in patients aged 70 years and older.
- Expert consensus and guideline development by the International Society of Geriatric Oncology (SIOG) NSCLC task force.
- Analysis of available data on efficacy, safety, and patient-centered outcomes in the geriatric population.
Main Results:
- Targeted therapies offer significant improvements in prognosis and quality of life for NSCLC patients.
- Limited data exist on the specific efficacy and tolerability of these agents in patients aged 70 years and older.
- Older patients present unique challenges including comorbidities, polypharmacy, and frailty.
Conclusions:
- Targeted therapies are crucial for oncogene-driven NSCLC, but their use in older adults requires careful consideration.
- Expert recommendations are needed to guide clinical decision-making for geriatric patients with NSCLC.
- Further research is essential to address the data gap in older populations receiving targeted cancer treatments.
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