Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta 83100, Avellino, Italy.
Lung Cancer. 2009 Dec;66(3):282-6. doi: 10.1016/j.lungcan.2009.08.006. Epub 2009 Oct 29.
Lung cancer in the older individual is an increasingly common problem faced by the oncologist. Elderly patients have more co-morbidities and tend to tolerate toxic medical treatments more poorly than their younger counterparts. Thus, clinical data obtained in a younger population cannot be automatically extrapolated to the great majority of non-selected elderly patients with non-small-cell lung cancer (NSCLC). The bulk of prospective clinical data regarding chemotherapy and molecularly targeted therapy for elderly NSCLC patients comes from studies in advanced disease. In elderly advanced NSCLC patients single-agent chemotherapy with third-generation agents (vinorelbine, gemcitabine, taxanes) is to be considered as the standard treatment for unselected patients, based on several phase II and III trials specifically designed for this special population. Retrospective analyses found no differences in survival between elderly and younger patients treated with cisplatin-based chemotherapy, with a small but significant increase in toxicity in the elderly. Cisplatin-based chemotherapy with cisplatin at attenuated doses has demonstrated to be an active and feasible option in phase II trials and deserves prospective phase III comparison against monochemotherapy. Among targeted therapies, the epidermal growth factor receptor tyrosine kinase inhibitors erlotinib and gefitinib are the most promising agents and have relevant phase II prospective data showing activity and good tolerability as first-line treatment in this population. Concerning the anti-vascular endothelial growth factor monoclonal antibody bevacizumab, particular care must be taken for elderly patients because of a possible higher incidence of cardiovascular co-morbidities. However its role in this population remains controversial and specific prospective studies are warranted to clarify this topic. Further specifically designed phase III randomized trials are needed to optimize medical treatment of NSCLC in elderly patients.
老年肺癌是肿瘤医生面临的一个日益常见的问题。老年患者合并症更多，且比年轻患者更难以耐受毒性药物治疗。因此，在年轻患者中获得的临床数据不能自动外推至绝大多数未经选择的老年非小细胞肺癌（NSCLC）患者。关于老年 NSCLC 患者化疗和分子靶向治疗的大部分前瞻性临床数据来自晚期疾病的研究。在老年晚期 NSCLC 患者中，基于专为该特殊人群设计的几项 II 期和 III 期试验，第三代药物（长春瑞滨、吉西他滨、紫杉烷类）的单药化疗被认为是未经选择患者的标准治疗。回顾性分析发现，接受顺铂为基础的化疗的老年和年轻患者之间的生存没有差异，老年患者的毒性略有增加，但有统计学意义。在 II 期试验中，顺铂低剂量联合化疗显示出活性且可行，值得与单药化疗进行前瞻性 III 期比较。在靶向治疗中，表皮生长因子受体酪氨酸激酶抑制剂厄洛替尼和吉非替尼是最有前途的药物，并且有相关的 II 期前瞻性数据显示在该人群中作为一线治疗具有活性和良好的耐受性。关于抗血管内皮生长因子单克隆抗体贝伐珠单抗，由于老年患者可能有更高的心血管合并症发生率，因此需要特别注意。然而，其在该人群中的作用仍存在争议，需要进行特定的前瞻性研究来阐明这一问题。需要进一步设计专门的 III 期随机试验来优化老年 NSCLC 患者的药物治疗。
