Non small-cell lung cancer in elderly - Which management?

Geriatric oncology has become recognised as a discrete speciality. Although there is a strong evidence base for using chemotherapy in patients with advanced non-small cell lung cancer, cisplatin administration is associated with significant toxicity and the evaluation of the risk benefit ratio should be particularly rigorous in elderly patients. With aging, hepatic metabolism, renal excretion, volume of distribution and albumin concentration decrease and drug concentration increases. To plan treatment for elderly patients, a multidimensional geriatric evaluation including not only performance status and the identification of comorbidities, but also an assessment of creatinine clearance, functional (activities of daily living), mental (mini-mental state evaluation and geriatric depression index) and nutritional status should be undertaken. On the basis of this comprehensive geriatric assessment it should be possible to identify three groups of older cancer patients; fit, vulnerable and frail and thus to propose appropriate treatment. Accepting that the ideal form of geriatric assessment remains to be defined, a comprehensive assessment to allow individualised treatment in elderly patients is mandatory.