Adjuvant Chemotherapy in Elderly Patients with Non-Small-Cell Lung Cancer

Cesare Gridelli, MD, Paolo Maione, MD, Daniela Comunale, MD, and Antonio Rossi, MD


Cancer Control. 2007;14(1):57-62. 

In This Article

Age Cutoff

Within epidemiologic literature, the age of 65 years is usually considered a cutoff point to identify an elderly population. On the contrary, in clinical trials, the age of 70 is frequently used as the lower limit for patient selection; this is based on the consideration that patients who are 65 to 70 years of age have a general health status that is good enough to benefit from treatment strategies that are commonly applied to younger patients. Furthermore, 70 years of age may be considered as the lower boundary of senescence because the incidence of age-related changes starts to increase after the age of 70 years.[18]

A cutoff age of 75 years is less common.Obviously, indirect comparison of trials that include patients who are 65 to 70 years of age and those that omit this age group may be biased. A further bias may be due to the distribution of the so-called "very old" patients, aged 80 years or more. The proportion of "very old" patients with lung cancer at presentation will increase in the next few years.[4] Thus, results from studies that primarily include patients in their 70s may not be completely generalizable to future generations of elderly patients. Furthermore, establishing a maximum age for chemotherapy treatment in the elderly is difficult. In clinical practice, biological instead of chronological age should be considered. Unfortunately, laboratory tests (ie, interleukin- 6) and geriatric evaluation are currently inadequate in defining aging; therefore, at present, chronological age should be used as a frame of reference for clinical trials. However, any chronological definition can be considered arbitrary, and biological criteria are needed.