Background: Newly diagnosed non-small cell lung cancer (NSCLC) pts ≥40% are over ≥70 y. Due to special parameters combined with PS (≥2), geriatric syndromes the therapeutic decision is a real challenge. The comorbidities make their accrual in trials very poor & receive single agent.
Aim: To document the epidemiological, therapeutic data in 160 pts NSCLC ≥70 y, median age 75 (70-86) y admitted in our Unit (January 2007 to June 2014).
Methods and results: A total of 112/116 (97%) patients (A young-elderly/B elderly-elderly: 63/49) received three cycles Paclitaxel-Carboplatin-Bev ± brain Rt (for brain disease) + G-CSF. Response rate (RR) was documented in 78/112 (70%): CR (3), PR (60) & SD (15). RR was 76% (48/63 patients) & 61% (30/49 patients) in A & B. From 16 pts with brain metastases, RR observed in 4 (25%) vs. 74/96 (77%). PFS of total group was 8 (3+ - 13+) mo& median OS 16 (3+ - 38+) mo. Febrile neutropenia (fatal 4.2 & 2 in A/B) was more common & observed in 64/112 (57%) pts, 33/63 (52%) & 31/49 (63%) in A/B. Anaemia grade III, was in 62 (55%) pts, 31/63 (49%) & 31/49 (63%) in groups A & B while thrombopenia grade III, in 44 (39%) pts, 23/63 (36.5%) & 21/49 (43%) for groups A & B. Mucositis gr III + IV observed in 16/63 (25%) & 22/49 (45%) A/B. Selected (≥80 years) pts (n=30), PS =3± brain metastases (n=12) ± ≥5 comorbidities, ± weight loss 7%, single agent therapy (vinorelbine 10, docetaxel 15 & gemcitabine 5) was given. 6 pts died prior three cycles & 24 evaluable. In 9 (37.5%) RR documented, median PFS 6 [3-10] mo & median OS 11 [5-16] mo. Severe neutropenia was common with docetaxel. From the 160 pts 4 (2.5%) EGFR mutated received TKI and are still PR with no toxicity.
Conclusions: Elderly NSCLC pts: 1. Prior therapy, a thorough evaluation of PS/comorbidities is hallmark; 2. Where chemotherapy is indicative, it should be given; 3. Mucositis seems to be a serious side effect in elderly; 4. Prophylaxis with G-CSF is necessary; 5. In selective pts >80 years, single agent therapy may be beneficial.
