Clinical evidence on the undertreatment of older and poor performance patients who have advanced non-small-cell lung cancer: is there a role for targeted therapy in these cohorts?

A significant proportion of patients who have advanced non-small-cell lung cancer (NSCLC) do not receive treatment even though they may benefit. For instance, studies linking the Surveillance Epidemiology and End Results and Medicare databases show that chemotherapy, even platinum-based doublets, produces a survival benefit in elderly patients who have NSCLC, but only about 30% receive such treatment. Patients with poor performance status and those with significant co-morbidities are also typically undertreated. However, recent clinical evidence suggests that treatment decisions for these populations must be reconsidered. With the emerging availability of validated molecular tools to predict response to specific therapies, the identification of those who may derive substantial benefit from certain interventions is possible even in currently under-served populations. All patients who have advanced NSCLC should be referred for treatment evaluation, even those who are considered ineligible for conventional cytotoxic chemotherapy, and for molecular testing used to match patients with available treatment options.