Very elderly patients and lung cancer in a tertiary care center: a real life experience

Background: Elderly patients with non-small cell lung cancer (NSCLC) constitute an important part of oncological practice. The peculiar features of patients with more than 75 years and the clinical pathway of patients with adenocarcinoma (ADC) or squamous cell carcinoma (SCC) have not been completely described. Patients and methods: Patients with A) histologically/citologically confrimed NSCLC, B) diagnosed in 2015-2016, C) >75 years, D) firstly evaluated in our Center were identified from a local prospective database. Demograpichal, staging and treatment data were collected. Differences among groups were analyzed using Chi-Square Test. Radiological response was classified as partial response (PR), stable disease (SD) and progressive disease (PD) according to RECIST 1.1. criteria. Toxicity was evaluated according to CTCAE version 4.0. Results: 32 patients were enrolled, 26 with ADC and 6 with SCC. Mean age was respectively 78,9 and 77,2 years. One third of patients had more than 80 years; 80% had arterial hypertension. Median number of medications tooken daily was 3. In nearly 85% of cases diagnosis came from a histological specimen; 50% of patients had a disease non suitable for surgery or radiotherapy.Table: E36ItemADC (n = 26,%)SCC (n = 6, %)pFemale,%42.316.7.24ECOG PS 2-317.550.0.11Left lung T57.633.3.10 Open table in a new tab The two groups differed in: The features and treatments of patients not suitable for local treatment were:–ADC (15 patients); 3 patients had mutated EGFR (2 del-ex19 e and 1 mut-ex21): 2 received 1st line afatinib with a mean PFS of 7.5 months and 1 patient with G3 rash. Among other 12 patients, 4 did not received any chemotherapy, 5 received 1st line single-agent vinorelbine and 3 platinum-based doublet (all the 3 patients had less than 77 years and ECOG PS 0-1 at diagnosis). Disease control rate (SD+PR) was globally 45% (5/11). Four patients had a treatment delay due to G2-3 toxicity, in 1 case a hospital admission was needed.–SCC (3 patients): 1 patient had mutated EGFR and received off-label 1st line afatinib (with a PFS of 7 months and a PR), 1 patient received 1st line paclitaxel and 1 patient 1st line cisplatin/gemcitabine (with a SD).Two patients had a treatment delay due to G2-3 toxicity. Conclusions: very elderly patients with NSCLC could be an important part of daily practice; a significant part of them, especially those affectd by ADC are in good general clinical conditions at iagnosis. Also in this population active treatments could be proposed.