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Published on: August 2, 2022
Management of brain metastases in older adults with non-small cell lung cancer
Julia Belone Lopes1, Daniel Schep2, Arjun Sahgal2
1Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Abstract:
Brain metastases (BrM) are a major cause of morbidity in patients with non-small-cell lung cancer (NSCLC). As global populations age and systemic therapies improve survival, the number of older individuals presenting with BrM continues to rise. However, older adults remain underrepresented in clinical trials. Thus, treatment decisions in this population are often based on limited evidence from randomized prospective studies. Beyond chronological age, older adults with cancer frequently present with multiple comorbidities, frailty, baseline cognitive impairment, and reduced physiologic reserve. These factors may contribute to suboptimal treatment in clinical practice and highlight that age alone is an insufficient surrogate for vulnerability, underscoring the need for individualized geriatric assessment. In this review, we summarize the available evidence for CNS-directed and systemic therapies in older patients with NSCLC and BrM, discuss the options for local and systemic treatment strategies, and examine how geriatric assessment tools can inform individualized treatment decisions in this underrepresented population.
Insights
Older adults with non-small cell lung cancer and brain metastases need personalized care. Geriatric assessments can guide treatment decisions for this underrepresented population.
Area of Science:
- Oncology
- Geriatrics
- Neurology
Background:
- Brain metastases (BrM) are a significant cause of morbidity in non-small cell lung cancer (NSCLC) patients.
- The aging global population leads to an increasing number of older adults with BrM.
- Older adults are underrepresented in clinical trials, limiting evidence for treatment decisions.
Purpose of the Study:
- To review current evidence for CNS-directed and systemic therapies in older NSCLC patients with BrM.
- To discuss local and systemic treatment strategies for this population.
- To examine the role of geriatric assessment in individualizing treatment.
Main Methods:
- Literature review of studies on NSCLC with BrM in older adults.
- Analysis of treatment options, including CNS-directed and systemic therapies.
- Evaluation of geriatric assessment tools for clinical decision-making.
Main Results:
- Limited evidence from prospective studies exists for treating older adults with BrM.
- Factors beyond chronological age, such as comorbidities and frailty, influence treatment.
- Geriatric assessment can identify vulnerabilities and inform personalized treatment plans.
Conclusions:
- Age alone is insufficient to determine treatment vulnerability in older adults with NSCLC and BrM.
- Individualized treatment decisions are crucial, supported by geriatric assessments.
- Further research is needed to address the treatment needs of this underrepresented group.
