Locally advanced non-small cell lung cancer in the elderly: What combination of therapy is best?

Elderly patients (≥70 years) currently make up about one half of all lung cancer patients in the USA. The normal aging process combined most often with years of smoking leads to physiologic limitations which make aggressive multimodality therapy more challenging. Large modern studies which employed aggressive chemotherapy plus radiotherapy (RT) found that fit elderly patients experienced more myelosuppression and specific non-hematologic toxicities than younger individuals. Despite some degree of increased toxicity from combined modality therapy, it appeared that the fit elderly patients had similar disease control and survival rates as younger patients. Additionally, studies have shown that elderly patients had better survival with the more aggressive regimens of concurrent chemotherapy and radiotherapy rather than sequential therapy or RT alone. These findings suggest that fit elderly patients with locally advanced NSCLC should be encouraged to receive combined modality therapy. Recent clinical trials have been performed specifically for elderly patients. These studies should help clinicians optimize future treatment for the elderly. Research should focus on decreasing treatment toxicity in all patients but especially in the elderly. Treatment-related toxicity may be lessened with the use of newer radiation delivery techniques and novel targeted therapy. Additionally, more studies are needed for elderly patients and those with limited performance status who are grossly underrepresented in current clinical trials.