Treatment of advanced non-small-cell lung cancer in the elderly: Results of an International Expert Panel

Cesare Gridelli, Matti Aapro, Andrea Ardizzoni, Lodovico Balducci, Filippo De Marinis, Karen Kelly, Thierry Le Chevalier, Christian Manegold, Francesco Perrone, Rafael Rosell, Frances Shepherd, Luigi De Petris, Massimo Di Maio, Corey Langer

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

The best treatment for elderly patients with advanced non-small-cell lung cancer (NSCLC) is still debated. To guide clinical management of these patients and suggest the priorities for clinical research in this field, an International Expert Panel met in Naples, Italy, on April 19 to 20, 2004. Results and conclusions based on a review of evidence available in the literature to date are presented in this article. A comprehensive geriatric assessment is recommended to better define prognosis and to predict tolerance to treatment. In the first randomized study dedicated to elderly NSCLC patients, single-agent vinorelbine showed superiority over supportive care alone, both in terms of survival and quality of life. In a large randomized trial, gemcitabine plus vinorelbine failed to show any advantage over either agent alone. Subset analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with an acceptable increase in toxicity for elderly patients. These data should be interpreted cautiously because retrospective subgroup analyses are encumbered by selection bias; hence, randomized trials dedicated to platinum-based chemotherapy for nonselected elderly patients are warranted. Several promising biologic therapies are under investigation; however, with present data, target-based agents as first-line treatment for elderly NSCLC patients are not yet recommended. Clinical research, with trials specifically designed for elderly patients, is mandatory. With the current evidence, single-agent chemotherapy with a third-generation drug (vinorelbine, gemcitabine, a taxane) should be the recommended option for nonselected elderly patients with advanced NSCLC. Platinum-based chemotherapy is a viable option for fit patients with adequate organ function. Best supportive care remains important, in addition to chemotherapy or as the exclusive option for patients who are unsuitable for more aggressive treatment.

Original languageEnglish (US)
Pages (from-to)3125-3137
Number of pages13
JournalJournal of Clinical Oncology
Volume23
Issue number13
DOIs
StatePublished - 2005
Externally publishedYes

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Non-Small Cell Lung Carcinoma
gemcitabine
Platinum
Therapeutics
Drug Therapy
Geriatric Assessment
Biological Therapy
Selection Bias
Proxy
Combination Drug Therapy
Research
Italy
Quality of Life
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of advanced non-small-cell lung cancer in the elderly : Results of an International Expert Panel. / Gridelli, Cesare; Aapro, Matti; Ardizzoni, Andrea; Balducci, Lodovico; De Marinis, Filippo; Kelly, Karen; Le Chevalier, Thierry; Manegold, Christian; Perrone, Francesco; Rosell, Rafael; Shepherd, Frances; De Petris, Luigi; Di Maio, Massimo; Langer, Corey.

In: Journal of Clinical Oncology, Vol. 23, No. 13, 2005, p. 3125-3137.

Research output: Contribution to journalArticle

Gridelli, C, Aapro, M, Ardizzoni, A, Balducci, L, De Marinis, F, Kelly, K, Le Chevalier, T, Manegold, C, Perrone, F, Rosell, R, Shepherd, F, De Petris, L, Di Maio, M & Langer, C 2005, 'Treatment of advanced non-small-cell lung cancer in the elderly: Results of an International Expert Panel', Journal of Clinical Oncology, vol. 23, no. 13, pp. 3125-3137. https://doi.org/10.1200/JCO.2005.00.224
Gridelli, Cesare ; Aapro, Matti ; Ardizzoni, Andrea ; Balducci, Lodovico ; De Marinis, Filippo ; Kelly, Karen ; Le Chevalier, Thierry ; Manegold, Christian ; Perrone, Francesco ; Rosell, Rafael ; Shepherd, Frances ; De Petris, Luigi ; Di Maio, Massimo ; Langer, Corey. / Treatment of advanced non-small-cell lung cancer in the elderly : Results of an International Expert Panel. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 13. pp. 3125-3137.
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AU - De Marinis, Filippo

AU - Kelly, Karen

AU - Le Chevalier, Thierry

AU - Manegold, Christian

AU - Perrone, Francesco

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AU - Shepherd, Frances

AU - De Petris, Luigi

AU - Di Maio, Massimo

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