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(Chest. 2005;128:947-957.)
© 2005 American College of Chest Physicians

Chemotherapy for Elderly Patients With Non-Small Cell Lung Cancer*

A Review of the Evidence

Cesare Gridelli, MD and Frances A. Shepherd, MD

* From the Division of Medical Oncology (Dr. Gridelli), ‘S.G. Moscati’ Hospital, Avellino, Italy; and University Health Network (Dr. Shepherd), Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.

Correspondence to: Cesare Gridelli, MD, Division of Medical Oncology, ‘S.G. Moscati’ Hospital, Via Circumvallazione 68, 83100 Avellino, Italy; e-mail: cgridelli{at}libero.it

Chemotherapy for elderly patients with non-small cell lung cancer (NSCLC) has been questioned due to the perceived potential for higher toxicity in this population, possibly attributable to progressive organ failure and comorbidities. This nonsystematic review presents the authors’ selection of key evidence for the use of chemotherapy for elderly patients with NSCLC. To date, single-agent chemotherapy with agents such as vinorelbine, gemcitabine, docetaxel, and paclitaxel has been a reasonable option. Data on nonplatinum-based combinations are limited, but recent investigations of gemcitabine plus vinorelbine failed to show superiority over either agent alone. Retrospective subset analyses from large randomized trials suggest that the efficacy and tolerability of platinum-based combination chemotherapy are similar in both the elderly and their younger counterparts. Further phase III trials that specifically examine platinum-based combinations in selected elderly NSCLC patients are therefore warranted. The potential impact of new targeted therapies—alone or in combination with chemotherapy—is being investigated.

Key Words: chemotherapy • elderly • non-small cell lung cancer




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