Systemic therapy for advanced non-small cell lung cancer in elderly patients and patients with a poor performance status
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
Treatment of patients with lung cancer depends upon the cell type (non-small cell versus small cell), tumor stage, molecular characteristics, and an assessment of the patient's overall medical condition. (See "Overview of the initial evaluation, treatment and prognosis of lung cancer".)
Patients with stage I, II, or III non-small cell lung cancer (NSCLC) are generally treated with curative intent using surgery, radiation therapy (RT), or a combined-modality approach that may also include chemotherapy (table 1). By contrast, patients with advanced NSCLC are frequently treated with palliative intent using systemic therapy. This includes patients who present with stage IV disease and those who relapsed following prior definitive treatment. (See "Overview of the treatment of advanced non-small cell lung cancer".)
Age and comorbidity may limit the ability to deliver therapy for advanced NSCLC. The median age of patients with newly diagnosed NSCLC in developed countries is approximately 68 years, and up to 40 percent are aged ≥70 years at diagnosis . Furthermore, patients with a borderline or poor performance status (ie, ECOG performance status ≥2 [(table 2)] or Karnofsky Performance Status (KPS) ≤70 [(table 3)]) comprise 30 to 40 percent of patients with advanced NSCLC . Such patients have often either been excluded from or are underrepresented in clinical trials.
The development of agents that target specific pathways involved in the development or progression of NSCLC has provided an alternative to chemotherapy and has led to a personalized approach to the treatment of advanced NSCLC. Targeted agents tend to be better tolerated and may have an important role in older patients and those with significant comorbidity. (See "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)
Systemic therapy in elderly and poor performance status patients with advanced NSCLC is discussed here.
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- CHEMOTHERAPY VERSUS TARGETED THERAPY
- Initial therapy
- Subsequent therapy
- SYSTEMIC CHEMOTHERAPY
- Single agent chemotherapy
- - Vinorelbine
- - Docetaxel
- - Other single agents
- Combination versus single agent chemotherapy
- Chemotherapy plus bevacizumab
- TARGETED THERAPY
- EGFR mutation
- ALK fusion oncogene
- ROS1 translocation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS