Real-life management and outcomes of octogenarians with non-small-cell lung cancer: A 10-year evolution

The proportion of patients aged ≥ 80 years with non-small-cell lung cancer (NSCLC) is rising, yet data on their management remain scarce. This study analysed changes in treatment and survival in this population over a decade.

The KBP-2010 and KBP-2020 cohorts are prospective, nationwide cohorts including patients diagnosed with primary lung cancer in France in 2010 and 2020, respectively. We compared the clinical characteristics, treatments and outcomes of KBP patients aged ≥ 80 years with NSCLC between 2010 and 2020.

Among 8941 patients in KBP-2020, 7797 presented NSCLC and 1017 (13.0%) were ≥ 80 years, of whom 33.7% were women, 40.4% had ECOG performance status ≥ 2 and 32.4% were never-smokers. Most patients had metastatic disease (localized 18.9%, locally advanced 18.8%, metastatic 62.3%). Among patients who underwent molecular screening, the most frequent alterations were activating EGFR mutations (25.8%). Between 2010 and 2020, significant increases were seen in the numbers of patients undergoing surgery for localized disease (26.0% vs 46.4%) and chemoradiotherapy for locally advanced disease (10.6% vs 19.1%). In metastatic disease, the use of systemic therapy increased from 52.1% of patients in 2010-55.9% in 2020, with a shift towards targeted therapies (from 14.9% to 19.5%), while the use of chemotherapy decreased (from 51.2% to 24.6%). Four-year overall survival rate improved from 6.3% in 2010-13.1% in 2020 (p < 0.0001).

Patients ≥ 80 years with NSCLC exhibit specific clinical and molecular profiles. Access to therapies improved over the decade 2010-2020, leading to significantly better survival outcomes.