Division of Medical Oncology, 'S.G. Moscati' Hospital, Contrada Amoretta, 83100 Avellino, Italy.
Ther Adv Med Oncol. 2010 Jul;2(4):251-60. doi: 10.1177/1758834010366707.
More than 40% of cases of all lung cancers are diagnosed in patients over the age of 70 years. Elderly patients have more comorbidities and tend to be less tolerant to toxic medical treatments than their younger counterparts. Thus, clinical data obtained in a younger population cannot be automatically extrapolated to the great majority of nonselected 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 come from studies in advanced disease. In elderly advanced NSCLC patients, single-agent chemotherapy with third-generation agents (vinorelbine, gemcitabine, taxanes) is to be considered the routine standard of care for unselected patients, based on phase II and III trials specifically designed for this special population. Cisplatin-based chemotherapy with cisplatin at attenuated doses has been demonstrated to be an active and feasible option in phase II trials. Among targeted therapies, the epidermal growth factor receptor tyrosine kinase inhibitors, erlotinib and gefitinib, have relevant phase II prospective data showing activity and good tolerability as first-line treatment in this population. Concerning the antivascular endothelial growth factor monoclonal antibody, bevacizumab, combined with chemotherapy, particular care must be taken for elderly patients because of the higher incidence of cardiovascular comorbidities. The lack of data on octogenarians suggest that clinicians should exercise caution when applying the existing data on chemotherapy and targeted therapies for patients aged 70-79 years to those aged >80 years. Further specifically designed clinical trials are needed to optimize medical treatment of NSCLC in elderly patients.
超过 40%的所有肺癌病例是在 70 岁以上的患者中诊断出来的。老年患者合并症较多，与年轻患者相比，他们对毒性药物治疗的耐受性较差。因此，在年轻人群中获得的临床数据不能自动外推到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，基于专门为这一特殊人群设计的 II 期和 III 期试验，第三代药物（长春瑞滨、吉西他滨、紫杉烷）的单药化疗被认为是未经选择的患者的常规标准治疗。基于顺铂的低剂量顺铂化疗已在 II 期试验中被证明是一种有效的可行选择。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具有相关的 II 期前瞻性数据，表明在该人群中作为一线治疗具有活性和良好的耐受性。对于抗血管内皮生长因子单克隆抗体贝伐珠单抗，由于心血管合并症的发生率较高，在老年患者中联合化疗时必须特别注意。由于缺乏关于 80 岁以上患者的相关数据，临床医生在将现有的关于 70-79 岁患者的化疗和靶向治疗数据应用于 80 岁以上患者时应谨慎。需要进一步进行专门设计的临床试验，以优化老年 NSCLC 患者的医疗治疗。
