Current Geriatrics Reports

, Volume 3, Issue 3, pp 166–174

Lung Cancer in Older Adults

Geriatric Oncology (TM Wildes, Section Editor)


Lung cancer is the leading cause of cancer-related mortality and is responsible for more deaths than breast cancer, prostate cancer, and colon cancer combined. The majority of patients diagnosed with lung cancer are over the age of 65. Despite the prevalence of lung cancer in older adults, they have been notoriously underrepresented in clinical trials designed to help guide clinicians in the management of treatment. In the past 15 years, there have been many improvements that collectively have extended the lives of patients with metastatic lung cancer an average of one year after diagnosis. It is now well-established that age does not diminish the benefit of cancer treatment. However, certain toxicities are more common and may be less tolerated in this age group. It is therefore of paramount importance that clinicians work together to tease out which patients will benefit the most from treatment and to minimize toxicity.


Lung cancer Elderly Geriatrics Older adults 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Howlader N, NA, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. 2013 April 2014.
  2. 2.••
    Pallis AG, 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. Advance online publication. doi:10.1093/annonc/mdu022. This consensus paper provides recent evidence and expert recommendations for the treatment of non-small cell lung cancer in older adults.
  3. 3.
    Siegel R et al. Cancer statistics. CA Cancer J Clin. 2014;64(1):9–29.PubMedCrossRefGoogle Scholar
  4. 4.
    Arias E. United States life tables, 2009. Natl Vital Stat Rep. 2014;62(7):1–63.PubMedGoogle Scholar
  5. 5.
    Melamed MR. Lung cancer screening results in the National Cancer Institute New York study. Cancer. 2000;89(11 Suppl):2356–62.PubMedCrossRefGoogle Scholar
  6. 6.••
    National Lung Screening Trial Research, T et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. This is a landmark randomized prospective study that provides evidence that low-dose CT screening could reduce cancer-related mortality in patients at high risk for lung cancer.CrossRefGoogle Scholar
  7. 7.•
    Moyer VA. Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;160(5):330–8. This is the recommendation provided by the U.S. Preventive Task Force to consider screening with low-dose CT scans for select patients at high risk of lung cancer.Google Scholar
  8. 8.
    Bach PB et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307(22):2418–29.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    de Koning HJ et al. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst. 1980;65(1):25–32.PubMedGoogle Scholar
  11. 11.
    Repetto L et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20(2):494–502.PubMedCrossRefGoogle Scholar
  12. 12.
    Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25(14):1824–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Pallis AG et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer. 2010;46(9):1502–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Travis WD. Pathology of lung cancer. Clin Chest Med. 2011;32(4):669–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson DH et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2004;22(11):2184–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Scagliotti GV et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21):3543–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Ettinger DS et al. Non-small cell lung cancer. J Natl Compr Canc Netw. 2010;8(7):740–801.PubMedGoogle Scholar
  18. 18.
    Fanucchi O et al. Surgical treatment of non-small cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg. 2011;12(5):749–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Rivera C et al. Surgical treatment of lung cancer in the octogenarians: results of a nationwide audit. Eur J Cardiothorac Surg. 2011;39(6):981–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Wang S et al. Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol. 2012;30(13):1447–55.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    British Thoracic Society, Society of Cardiothoracic Surgeons of Great Britain and Ireland Working Party. BTS guidelines: guidelines on the selection of patients with lung cancer for surgery. Thorax. 2011;56(2):89–108.Google Scholar
  22. 22.
    Ginsberg RJ et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg. 1983;86(5):654–8.PubMedGoogle Scholar
  23. 23.
    Allen MS et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81(3):1013–9. discussion 1019-20.PubMedCrossRefGoogle Scholar
  24. 24.
    Gray SW et al. Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer. Cancer. 2012;118(5):1404–11.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    McKenna Jr RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81(2):421–5. discussion 425-6.PubMedCrossRefGoogle Scholar
  26. 26.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group Ann Thorac Surg. 1995;60(3):615–22. discussion 622-3.CrossRefGoogle Scholar
  27. 27.
    Okami J et al. Sublobar resection provides an equivalent survival after lobectomy in elderly patients with early lung cancer. Ann Thorac Surg. 2010;90(5):1651–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Cuffe S et al. Adjuvant chemotherapy for non-small-cell lung cancer in the elderly: a population-based study in Ontario, Canada. J Clin Oncol. 2012;30(15):1813–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Wisnivesky JP et al. Postoperative radiotherapy for elderly patients with stage III lung cancer. Cancer. 2012;118(18):4478–85.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Timmerman R et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24(30):4833–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Timmerman R et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070–6.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Dunlap NE et al. Size matters: a comparison of T1 and T2 peripheral non-small-cell lung cancers treated with stereotactic body radiation therapy (SBRT). J Thorac Cardiovasc Surg. 2010;140(3):583–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Hiraoka M, Ishikura S. A Japan clinical oncology group trial for stereotactic body radiation therapy of non-small cell lung cancer. J Thorac Oncol. 2007;2(7 Suppl 3):S115–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Hurkmans CW et al. Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol. 2009;4:1.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Davidoff AJ et al. Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2191–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Furuse K et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 1999;17(9):2692–9.PubMedGoogle Scholar
  37. 37.
    Curran Jr WJ et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011;103(19):1452–60.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Gandara DR et al. Consolidation docetaxel after concurrent chemoradiotherapy in stage IIIB non-small-cell lung cancer: phase II Southwest Oncology Group Study S9504. J Clin Oncol. 2003;21(10):2004–10.PubMedCrossRefGoogle Scholar
  39. 39.
    Hanna N et al. Phase III study of cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small-cell lung cancer: the Hoosier Oncology Group and U.S. Oncology. J Clin Oncol. 2008;26(35):5755–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Belani CP et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005;23(25):5883–91.PubMedCrossRefGoogle Scholar
  41. 41.
    Atagi S et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol. 2012;13(7):671–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by the American Society of Clinical Oncology. J Clin Oncol. 1997;15(8): p. 2996-3018.Google Scholar
  43. 43.
    Azzoli CG, Giaccone G, Temin S. American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer. J Oncol Pract. 2010;6(1):39–43.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Gridelli C. The ELVIS trial: a phase III study of single-agent vinorelbine as first-line treatment in elderly patients with advanced non-small cell lung cancer. Elderly Lung Cancer Vinorelbine Italian Study. Oncologist. 2001;6 Suppl 1:4–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Langer CJ et al. Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst. 2002;94(3):173–81.PubMedCrossRefGoogle Scholar
  46. 46.
    Go RS, Adjei AA. Review of the comparative pharmacology and clinical activity of cisplatin and carboplatin. J Clin Oncol. 1999;17(1):409–22.PubMedGoogle Scholar
  47. 47.•
    Zukin M et al. Randomized phase III trial of single-agent pemetrexed versus carboplatin and pemetrexed in patients with advanced non-small-cell lung cancer and Eastern Cooperative Oncology Group performance status of 2. J Clin Oncol. 2013;31(23):2849–53. This trial provides prospective randomized data that establishes the safety and efficacy of combination chemotherapy in patients with advanced non-small cell lung cancer and a performance status of 2.PubMedCrossRefGoogle Scholar
  48. 48.•
    Socinski MA et al. Safety and efficacy of weekly nab(R)-paclitaxel in combination with carboplatin as first-line therapy in elderly patients with advanced non-small-cell lung cancer. Ann Oncol. 2013;24(2):314–21. This paper discusses the results of a subgroup analysis of patients over the age of 70 who were treated with carboplatin and either paclitaxel or nab-paclitaxel. The overall survival was approximately twice as long for elderly patients treated with carboplatin and nab-paclitaxel.PubMedCrossRefGoogle Scholar
  49. 49.
    Gridelli C et al. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003;95(5):362–72.PubMedCrossRefGoogle Scholar
  50. 50.
    Sandler A et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355(24):2542–50.PubMedCrossRefGoogle Scholar
  51. 51.
    Ramalingam SS et al. Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol. 2008;26(1):60–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Zhu J et al. Carboplatin and paclitaxel with vs without bevacizumab in older patients with advanced non-small cell lung cancer. JAMA. 2012;307(15):1593–601.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Laskin J et al. Safety and efficacy of first-line bevacizumab plus chemotherapy in elderly patients with advanced or recurrent nonsquamous non-small cell lung cancer: safety of avastin in lung trial (MO19390). J Thorac Oncol. 2012;7(1):203–11.PubMedCrossRefGoogle Scholar
  54. 54.
    Wazniak AJ, JG, Jahanzeb M, Kosty MP, Vidaven R, Beatty S, Teng S, Flick ED, Sing A, Lynch TJ. Clinical outcomes (CO) for special populations of patients (pts) with advanced non-small cell lung cancer (NSCLC): Results from ARIES, a bevacizumab (BV) observational cohort study (OCS). J Clin Oncol. 2010;28(15s): p. suppl; abstr 7618.Google Scholar
  55. 55.
    Lynch TJ et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350(21):2129–39.PubMedCrossRefGoogle Scholar
  56. 56.
    Paez JG et al. EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science. 2004;304(5676):1497–500.PubMedCrossRefGoogle Scholar
  57. 57.
    Pao W et al. EGF receptor gene mutations are common in lung cancers from "never smokers" and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci U S A. 2004;101(36):13306–11.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Wakeling AE et al. ZD1839 (Iressa): an orally active inhibitor of epidermal growth factor signaling with potential for cancer therapy. Cancer Res. 2002;62(20):5749–54.PubMedGoogle Scholar
  59. 59.
    Cohen MH et al. United States Food and Drug Administration Drug Approval summary: Gefitinib (ZD1839; Iressa) tablets. Clin Cancer Res. 2004;10(4):1212–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Giaccone G et al. Gefitinib in combination with gemcitabine and cisplatin in advanced non-small-cell lung cancer: a phase III trial–INTACT 1. J Clin Oncol. 2004;22(5):777–84.PubMedCrossRefGoogle Scholar
  61. 61.
    Herbst RS et al. Gefitinib in combination with paclitaxel and carboplatin in advanced non-small-cell lung cancer: a phase III trial–INTACT 2. J Clin Oncol. 2004;22(5):785–94.PubMedCrossRefGoogle Scholar
  62. 62.
    Rosell R et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239–46.PubMedCrossRefGoogle Scholar
  63. 63.
    Li D et al. BIBW2992, an irreversible EGFR/HER2 inhibitor highly effective in preclinical lung cancer models. Oncogene. 2008;27(34):4702–11.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Sequist LV et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013;31(27):3327–34.PubMedCrossRefGoogle Scholar
  65. 65.
    Miller VA et al. Afatinib versus placebo for patients with advanced, metastatic non-small-cell lung cancer after failure of erlotinib, gefitinib, or both, and one or two lines of chemotherapy (LUX-Lung 1): a phase 2b/3 randomised trial. Lancet Oncol. 2012;13(5):528–38.PubMedCrossRefGoogle Scholar
  66. 66.
    Shaw AT et al. Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK. J Clin Oncol. 2009;27(26):4247–53.PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Kwak EL et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010;363(18):1693–703.PubMedCentralPubMedCrossRefGoogle Scholar
  68. 68.
    Shaw AT et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013;368(25):2385–94.PubMedCrossRefGoogle Scholar
  69. 69.
    Shaw AT et al. Ceritinib in ALK-rearranged non-small-cell lung cancer. N Engl J Med. 2014;370(13):1189–97.PubMedCrossRefGoogle Scholar
  70. 70.
    Bergethon K et al. ROS1 rearrangements define a unique molecular class of lung cancers. J Clin Oncol. 2012;30(8):863–70.PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Micke P et al. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer–what limits limited disease? Lung Cancer. 2002;37(3):271–6.PubMedCrossRefGoogle Scholar
  72. 72.
    Takada M et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol. 2002;20(14):3054–60.PubMedCrossRefGoogle Scholar
  73. 73.
    Yuen AR et al. Similar outcome of elderly patients in intergroup trial 0096: Cisplatin, etoposide, and thoracic radiotherapy administered once or twice daily in limited stage small cell lung carcinoma. Cancer. 2000;89(9):1953–60.PubMedCrossRefGoogle Scholar
  74. 74.
    Rossi A et al. Treatment of small cell lung cancer in the elderly. Oncologist. 2005;10(6):399–411.PubMedCrossRefGoogle Scholar
  75. 75.
    Quoix E et al. Etoposide phosphate with carboplatin in the treatment of elderly patients with small-cell lung cancer: a phase II study. Ann Oncol. 2001;12(7):957–62.PubMedCrossRefGoogle Scholar
  76. 76.
    Arriagada R et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst. 1995;87(3):183–90.PubMedCrossRefGoogle Scholar
  77. 77.
    Slotman BJ et al. Prophylactic cranial irradiation in extensive disease small-cell lung cancer: short-term health-related quality of life and patient reported symptoms: results of an international Phase III randomized controlled trial by the EORTC Radiation Oncology and Lung Cancer Groups. J Clin Oncol. 2009;27(1):78–84.PubMedCentralPubMedCrossRefGoogle Scholar
  78. 78.
    Kelley AS, Meier DE. Palliative care–a shifting paradigm. N Engl J Med. 2010;363(8):781–2.PubMedCrossRefGoogle Scholar
  79. 79.
    Temel JS et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Medicine, Division of OncologyWashington University School of MedicineSt. LouisUSA

Personalised recommendations