Treatment of Non-Small Cell Lung Cancer in the Older Population

Hossein Borghaei, DO, is joined by Stuart Lichtman, MD, and Balazs Halmos, MD, for a roundtable discussion on the treatment of advanced non–small cell lung cancer (NSCLC) in older patients. The panelists report that most of their patients are older, but patients who are in their seventh, eighth, or ninth decade of life are greatly underrepresented in clinical trials. The limited evidence regarding optimal treatment of older patients with NSCLC poses challenges in identifying the right treatment for a given patient.

The first step entails understanding the patient's goals, assessing their functional status, and identifying any targetable genetic mutations of their cancer. They discuss at length the need to balance potential clinical benefit against potential toxicity, whether the treatment being considered is a targeted therapy, immunotherapy, or chemotherapy. Of note, they underscore that even grade 2 toxicity can severely affect quality of life in patients with limited life expectancy. The panelists discuss current evidence concerning first-line and second-line therapies but underscore the need for more clinical trials that include older patients to better inform treatment of this specific population of patients with NSCLC.