Lung cancer in older patients

Increasing life expectancy is the goal of social programs in the Russian Federation as a reflection of the success of public health. Globally, there is a trend for aging of the population, contributing to an increased risk for lung cancer developing which is primarily a disease of the elderly. Chronologic age or performance scores alone are not accurate predictors of patients’ capacity for tolerating aggressive cancer therapies. Use of a comprehensive geriatric assessment to determine treatment strategy is able to reduce toxicities and treatment failures. Safe elderly patients are often able to tolerate surgical resection, radiation, and/or chemotherapy appropriate for their tumor stage, with outcomes similar to those of younger patients, albeit with higher rates of treatment-related toxicity.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. PMID: 30620402. https://doi.org/10.3322/caac.21551

2. Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends – an update. Cancer Epidemiol Biomarkers Prev. 2016;25(1):16–27. PMID: 26667886. https://doi.org/10.1158/1055-9965.EPI-15-0578

3. Presley CJ, Gross CP, Lilenbaum RC. Optimizing treatment risk and benefit for elderly patients with advanced nonsmall-cell lung cancer: the right treatment for the right patient. J Clin Oncol. 2016;34(13):1438–42. PMID: 27001591. https://doi.org/10.1200/JCO.2015.65.9599

4. Venuta F, Diso D, Onorati I, Anile M, Mantovani S, Rendina EA. Lung cancer in elderly patients. J. Thorac. Dis. 2016;8(11):908–14. PMID: 27942414. PMCID: PMC5124601. https://doi.org/10.21037/jtd.2016.05.20

5. Cancer research UK. Lung cancer incidence statistics. Accessed March 29, 2016. Available online: www.cancerresearchuk.org

6. Saji H, Ueno T, Nakamura H, et al. A proposal comprehensive risk scoring system for predicting postoperative complications in octagenarian patients with medically operable lung cancer: JACS1303. Eur J Cardiothorac Surg. 2018;53:835– 41. PMID: 29240884. https://doi.org/10.1093/ejcts/ezx415

7. Malignant tumors in Russia in 2019 (morbidity and mortality). Ed. by A.D. Кaprin, V.V. Starinskii, A.O. Shachzadova Moscow 2020: MNIOI im. P.A. Gertsena – filial NMITs radiologii, 2020. (In Russ.)

8. Peter M. Healthy Patients at Risk for Lung Cancer: Whether, How, and Who to Screen. Ch. 13 in Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management. Ed. by L. Tanque and F. Dettrbeck 2019., Elsevier Inc. p. 197–208.

9. Dawe DE, Pond GR, Ellis PM. Assessment of referral and chemotherapy treatment patterns for elderly patients with nonsmall-cell lung cancer. Clin Lung Cancer. 2016;17(6):563–572.e2. PMID: 27374398. https://doi.org/10.1016/j.cllc.2016.05.012

10. Sineshaw HM, Wu XC, Flanders WD, et al. Variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) by state. J Thorac Oncol. 2016;11(6):880–9. PMID: 26980472. https://doi.org/10.1016/j.jtho.2016.03.003

11. Souza RV, Basis M, Mantovani S, et al. Comparison of preoperative scores predicting outcome in elderly undergoing lung malignancies resection. J Thorac. Dis. 2020;12(12):7083– 88. PMID: 33447396. PMCID: PMC7797853. https://doi.org/10.21037/jtd-20-1622

12. NCCN Guidelines: Older Adult Oncology. NCCN clinical practice guidelines in oncology 2016, 2. 2016. Available online: https://www.nccn.org/professionals/physiciangls/fguidelines.asp

13. Corre R, Greillier L, Le Caer H, et al. Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol. 2016;34(13):1476–83. PMID: 26884557. https://doi.org/10.1200/JCO.2015.63.5839

14. Gardet E, Tabutin M, Couraud S, et al. Long-term results of lung cancer surgery in octogenarians. Rev Pneumol Clin. 2016;72(1):3–9. (In French). PMID: 26725006. https://doi.org/10.1016/j.pneumo.2015.09.005

15. Detillon DE, Aarts MJ, Jaeger KD, Van Eijck CH, Eelco JV. Detillon DE, Aarts MJ, Jaeger KD, Van Eijck CH, Eelco JV. Video-assisted thoracic lobectomy versus stereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis. Eur Respir J. 2019;53(6):1801561. PMID: 30923188. https://doi.org/10.1183/13993003.01561-2018

16. Pagès P-B., Mariet A-S, Madelaine L, Cottenet J, et al. Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians. J Thorac Cardiovasc Surg. 2019;157(4):1660–67. PMID: 30711277. https://doi.org/10.1016/j.jtcvs.2018.11.098

17. Drevet G, Maury J-M, Ginoux M, Tronc F. Morbimortalité de la résection pulmonaire pour cancer par chirurgie vidéo-assistée chez l’octogénaire. Rev Mal Respir. 2020;37(4):293– 298. (In French). PMID: 32273117. https://doi.org/10.1016/j.rmr.2020.01.007

18. Bravo-Iniguez CE, Armstrong KW, Cooper Z, et al. Thirtyday mortality after lobectomy in elderly patients eligible for lung cancer screening. Ann Thorac Surg. 2016;101(2):541–6. PMID: 26603020. https://doi.org/10.1016/j.athoracsur.2015.08.067

19. Smith CB, Kale M, Mhango G, et al. Comparative outcomes of elderly stage I lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection. J Thorac Oncol. 2014;9(3):383–9. PMID: 24495998. https://doi.org/10.1097/JTO.0000000000000083

20. Razi SS, John MM, Sainathan S, et al. Sublobar resection is equivalent to lobectomy for T1a non-small cell lung cancer in the elderly: a surveillance, epidemiology, and end results database analysis. J Surg Res. 2016;200(2):683–9. PMID: 26490227. https://doi.org/10.1016/j.jss.2015.08.045

21. Zhang Y, Yuan C, Zhang Y, et al. Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer. Oncotarget. 2016;7(14):19081–6. PMID: 26934652 PMCID: PMC4951354. https://doi.org/10.18632/oncotarget.7704

22. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med. 2018;6(12):915–924. PMID: 30442588. PMCID: PMC6396275. https://doi.org/10.1016/S2213-2600(18)30411-9

23. Kato A, Yokomise H. [Perioperative Management for Lung Cancer in the Elderly Over 75 Years Old.] Kyobu Geka. 2020 Sep;73(10):812-818 (In Jap.).

24. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: non-small cell lung cancer. Version 1.2020-November 6, 2019. Available online: www.nccn.org/professionals/physiciangls/pdf/nscl.pdf.

25. Nanda RH, Liu Y, Gillespie TW, et al. Stereotactic body radiation therapy versus no treatment for early stage non-small cell lung cancer in medically inoperable elderly patients: a National cancer data base analysis. Cancer. 2015;121(23): 4222–30. PMID: 26348268. https://doi.org/10.1002/cncr.29640

26. Paul S, Lee PC, Mao J, et al. Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis. BMJ. 2016;354:i3570. PMID: 27400862. PMCID: PMC4937638. https://doi.org/10.1136/bmj.i3570

27. Dupuy DE, Fernando HC, Hillman S, et al. Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. Cancer. 2015;121(19):3491–8. PMID:26096694. PMCID:PMC4578219. https://doi.org/10.1002/cncr.29507

28. Ganti AK, Williams CD, Gajra A, et al. Effect of age on the efficacy of adjuvant chemotherapy for resected non–small cell lung cancer. Cancer. 2015;121(15):2578–85. PMID: 25873330. https://doi.org/10.1002/cncr.29360

29. Dawe DE, Christiansen D, Swaminath A, et al. Chemoradiotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: a systematic review and meta-analysis. Lung Cancer. 2016;99:180–5. PMID: 27565937. https://doi.org/10.1016/j.lungcan.2016.07.016

30. Sacher AG, Dahlberg SE, Heng J, et al. Association between younger age and targetable genomic alterations and prognosis in non–small-cell lung cancer. JAMA Oncol. 2016;2(3):313–20. PMID: 26720421. PMCID: PMC4819418. https://doi.org/10.1001/jamaoncol.2015.4482

31. Awad MM, Oxnard GR, Jackman DM, et al. MET Exon 14 mutations in non–smallcell lung cancer are associated with advanced age and stage-dependent MET genomic amplification and c-Met overexpression. J Clin Oncol. 2016;34(7):721–30. PMID: 26729443. https://doi.org/10.1200/JCO.2015.63.4600

32. Barlesi F, Mazieres J, Merlio JP, et al. Routine molecular profiling of patients with advanced non-small-cell lung cancer: results of a 1-year nationwide programme of the French Cooperative Thoracic Intergroup (IFCT). Lancet. 2016;387(10026):1415–26. PMID: 26777916. https://doi.org/10.1016/S0140-6736(16)00004-0

33. McLoughlin EM, Gentzler RD. Epidermal Growth Factor Receptor Mutations. Thorac. Surg. Clin. 2020;30:127–136. PMID: 32327171. https://doi.org/10.1016/j.thorsurg.2020.01.008

34. Reckamp KL, Molecular Targets Beyond the Big 3. Thorac. Surg Clin. 2020;30:157–164. PMID: 32327174. https://doi.org/10.1016/j.thorsurg.2020.01.004

35. Hsu M, Naidoo J. Principles of Immunotherapy in NonSmall Cell Lung Cancer. Thorac Surg Clin. 2020;30:187–198. PMID: 32327177 https://doi.org/10.1016/j.thorsurg.2020.01.009

36. Broderick SR. Adjuvant and Neoadjuvant Immunotherapy in Non–small Cell Lung Cancer. Thorac Surg Clin. 2020;30(2):215–220. PMID: 32327180. https://doi.org/10.1016/j.thorsurg.2020.01.001

37. Antonia SJ, Lopez-Martin JA, Bendell J, et al. Nivolumab alone and nivolumab plus ipilimumab in recurrent small-cell lung cancer (CheckMate 032): a multicentre, open-label, phase 1/2 trial. Lancet Oncol. 2016;17(7):883–95. PMID: 27269741. https://doi.org/10.1016/S1470-2045(16)30098-5