Management of Lung Cancer in the Elderly
Lung cancer is the leading cause of cancer-associated mortality in the USA. The median age at diagnosis of lung cancer is 70 years, and thus, about one-half of patients with lung cancer fall into the elderly subgroup. There is dearth of high level of evid
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Abstract
Lung cancer is the leading cause of cancer-associated mortality in the USA. The median age at diagnosis of lung cancer is 70 years, and thus, about one-half of patients with lung cancer fall into the elderly subgroup. There is dearth of high level of evidence regarding the management of lung cancer in the elderly in the three broad stages of the disease including early-stage, locally advanced, and metastatic disease. A major reason for the lack of evidence is the underrepresentation of elderly in prospective randomized clinical trials. Due to the typical decline in physical and physiologic function associated with aging, most elderly do not meet the stringent eligibility criteria set forth in age-unselected clinical trials. In addition to performance status, ideally, comorbidity, cognitive, and psychological function, polypharmacy, social support, and patient preferences should be taken into account before applying prevailing treatment paradigms often derived in younger, healthier patients to the care of the elderly patient with lung cancer. The purpose of this chapter was to review the existing evidence of management of early-stage, locally advanced disease, and metastatic lung cancer in the elderly. Keywords
Lung cancer
Elderly Geriatric assessment
A. Rao N. Sharma A. Gajra (&) Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA e-mail: [email protected] © Springer International Publishing Switzerland 2016 K.L. Reckamp (ed.), Lung Cancer, Cancer Treatment and Research 170, DOI 10.1007/978-3-319-40389-2_12
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Contents 1 Management of Early-Stage Disease .................................................................................. 1.1 The Role of Surgery................................................................................................... 1.2 Role of Radiation Therapy in Early-Stage Lung Cancer .......................................... 1.3 Role of Adjuvant Chemotherapy in Early-Stage Lung Cancer.................................
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2 Management of Locally Advanced Non-small Cell Lung Cancer (LA-NSCLC).............. 261 3 Management of Advanced Metastatic Lung Cancer in the Elderly ................................... 3.1 Single-Agent Therapy................................................................................................. 3.2 Doublet Chemotherapy............................................................................................... 3.3 Age-Based Subset Analyses from Phase III Trials.................................................... 3.4 Population-Based Studies in Elderly.......................................................................... 3.5 Geriatric Assessment-Based Study in the Elderly ..................................................... 3.6 Role of Targeted Therapy in the Treatment of Metastatic Lung Cancer in the Elderly
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4 Issues Specific to the Elderly ..............................................................................
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