Home  |  About the Book  |  Table of Contents  |  Search  |  Archive  |  Order  |  Visit JCO  |  Visit ASCO.org
ASCO Educational Book; 2009
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar content in this book
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gridelli, C.
Right arrow Articles by Rossi, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Gridelli, C.
Right arrow Articles by Rossi, A.

Chemotherapy and Targeted Therapy for Older Patients with Advanced Non-small Cell Lung Cancer

Cesare Gridelli, MD, Paolo Maione, MD, and Antonio Rossi, MD

From the Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests: Cesare Gridelli, MD, Chief of the Division of Medical Oncology and Director of the Department of Oncology/Hematology, S.G. Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; e-mail: cgridelli{at}libero.it

Overview: Lung cancer in older patients is an increasingly common problem facing the oncologist. Elderly patients have more comorbidities and tend to be more intolerant of toxic medical treatments than their younger counterparts. Thus, clinical data obtained in a younger population cannot be automatically extrapolated to the great majority of non-selected elderly patients with non-small cell lung cancer (NSCLC). In elderly patients with advanced NSCLC single-agent chemotherapy — with third-generation agents (vinorelbine, gemcitabine, and taxanes) — is considered the standard treatment for unselected patients. Retrospective analyses found no differences in survival between elderly and younger patients treated with cisplatin-based chemotherapy; however, there was a small, but significant, increase in toxicity in the elderly. Cisplatin-based chemotherapy with cisplatin at attenuated doses has been shown to be an active and feasible option in phase II trials and deserves prospective phase III comparison against monochemotherapy. Among targeted therapies, the epidermal growth factor receptor tyrosine kinase inhibitors erlotinib and gefitinib are the most promising agents, and have relevant phase II prospective data showing activity and good tolerability as first-line treatment in this population. Concerning the anti-vascular endothelial growth factor monoclonal antibody bevacizumab, particular care should be taken for elderly patients because of the higher incidence of cardiovascular comorbidities. Specifically designed phase III randomized trials are needed to optimize medical treatment of NSCLC in elderly patients.