Management of lung cancer in older adults

More than half of the patients diagnosed with lung cancer are older than 70 years. Good knowledge of the special needs of these patients in diagnosis and treatment is essential for proper management of older adults with lung cancer.

For this narrative review, an exploratory literature search was conducted using the keywords “lung cancer”, “elderly”, “geriatric”, and “frailty”.

Common diagnostic and therapeutic procedures in older adults with lung cancer are bronchoscopy for histological diagnosis and molecular tissue analyses, staging with computed tomography (CT), positron emission tomography CT (PET-CT) and magnetic resonance imaging (MRI), surgical tumor resection, radiotherapy and systemic therapy including treatment with immune checkpoint or kinase inhibitors. Frailty is common in this group of patients and the geriatric assessment (GA) is suitable for determining the extent of frailty of individual cases. These diagnostic procedures do not pose a high risk even in very old age. Age per se should not preclude curative treatment approaches. Assessment of frailty by GA prior to adjuvant or palliative systemic treatment together with subsequent targeted geriatric interventions improve outcomes of older patients with lung cancer (less treatment toxicity).

Management of lung cancer in advanced age requires careful tailoring of diagnostic and therapeutic measures to tumor characteristics, frailty profile and preferences but not the age of individual patients.