Treatment of elderly patients or patients who are performance status 2 (PS2) with advanced Non-Small Cell Lung Cancer without epidermal growth factor receptor ( EGFR ) mutations and anaplastic lymphoma kinase ( ALK ) translocations – Still a daily challenge

摘要

Abstract Cytotoxic chemotherapy remains the core treatment strategy for patients with advanced non-small cell lung cancer (NSCLC) with tumours that do not have actionable molecular alterations, such as epidermal growth factor receptor ( EGFR )-sensitising mutations, anaplastic lymphoma kinase ( ALK ) translocations?or ROS1 translocations. Age and performance status (PS) are two pivotal factors to guide treatment decisions regarding the use of chemotherapy in lung cancer patients. Lung cancer is predominantly a disease of the elderly, with more than two-thirds of patients aged ≥65 years, the current definition of ‘elderly’. The prevalence of poor PS, as estimated by patients themselves, can be as high as 50%. Both the elderly and PS2 patients are underrepresented in clinical trials. Therefore, optimising treatment strategy for the subgroup of elderly or PS2 patients with advanced NSCLC remains challenging as a result of a paucity of clinical trial data. The current review focusses on the elderly or PS2 patients without actionable oncogenic drivers and attempts to summarise current available data on recent treatments trials including angiogenesis inhibitors and immune-checkpoint inhibitors. Highlights ? Clinical trials in both the elderly and PS 2 patients should avoid predictable toxicities. ? Carboplatin is the second drug of choice in a fit elderly patient. However if an elderly patient has a PS of 2 then single agent chemotherapy is the best choice. ? Angiogenesis inhibitors in elderly patients with advanced NSCLC are not recommended, but immune-checkpoint inhibitors are supported by data. ? Because of the increased rates of toxicity, dose-attenuated doublets or single-agent chemotherapy is recommended for PS 2 patients to alleviate symptoms. ? Evidence does not support the use of bevacizumab in patients with PS2 currently. Immunotherapy trials are ongoing.