Management of unfit older patients with advanced NSCLC

Lung cancer in the older individual is an increasingly common problem faced by the oncologist. Elderly patients over 70 years account about 40% of lung cancer patients. Performance Status 2 patients represent a significantly high proportion of advanced non-small cell lung cancer (NSCLC) patients (30-40%) when population-based surveys are conducted. Thus, unfit older patients represent a significant proportion of advanced NSCLC patients, for whom specific prospective data are very scarce. Elderly cancer patients often present with medical and physiological challenges that make the selection of their optimal treatment daunting. Single-agent chemotherapy should be considered the standard treatment for unfit older patients with advanced NSCLC. Molecularly targeted therapies as erlotinib and gefitinib, if approved for use in the next future also in the first-line treatment of advanced NSCLC, may represent a valid alternative to single-agent chemotherapy for a large proportion of unfit older patients because of their more favourable safety profile. However, specific prospective investigation is absolutely warranted for this special population.