In 2010, the European Organisation for Research and Treatment of Cancer (EORTC) - Cancer in the Elderly Task Force and Lung Cancer Group - along with the International Society for Geriatric Oncology (SIOG) wrote an expert opinion on managing treatment for elderly patients with non-small cell lung cancer (NSCLC). Since this publication, important new data are available and both organisations, EORTC and SIOG decided to update the 2010 recommendations. In an article published online on 16 March 2014 in the Annals of Oncology, they have updated their expert opinion.
Half of all patients diagnosed with NSCLC are 70 years of age or older, yet despite this high percentage, these elderly patients are not well represented in clinical trials. Therefore, the paucity of clinical data has made it difficult to reach evidence based clinical recommendations.
The update includes recommendations for screening, surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease as well as new data on patient preferences and geriatric assessment.
In an accompanied news released by EORTC, Dr Mary O`Brien of the Royal Marsden Hospital, UK, and Chair of the EORTC Lung Cancer Group advises, “Treatment decisions for elderly patients with NSCLC should not be based on their chronological age alone; there are many other factors that need to be considered. For instance, what is the patient’s life expectancy and preferences? What are the expected benefits and risks of the treatment?”
Dr Ulrich Wedding of the University Clinic in Jena, Germany, Chair of the SIOG Publications Committee, and Treasurer of the EORTC Cancer in the Elderly Task Force said, “People do not all age the same, so we also need to consider their biological or functional age when deciding on treatment. Multidimensional, multidisciplinary, comprehensive geriatric assessment can lead to better treatment for elderly patients with NSCLC.”
Several prospective clinical studies concerning both locally advanced and metastatic disease lend support to the feasibility of age-specific clinical trials and provide reliable data, as well, that can be used to guide treatment decisions.
The EORTC and SIOG researchers advocate that more effort should be made to develop such studies in other disease stages, and efforts should also be made to include patients more representative of the general elderly population, not just very fit patients.
This research was supported by Fonds Cancer (FOCA) from Belgium.
Pallis AG, Gridelli C, Wedding U, et al. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; First published online March 16. doi: 10.1093/annonc/mdu022