Octogenarians with advanced non-small cell lung cancer: treatment modalities, survival, and prognostic factors

INTRODUCTION: Lung cancer has become a disease of elderly. However, there are limited data describing the specific therapies, including epidermal growth factor receptor- tyrosine kinase inhibitor (EGFR-TKI), for octogenarians with advanced non-small cell lung cancer (NSCLC). This study is to characterize the treatment modalities and outcomes for octogenarians with advanced NSCLC and to investigate the impact of EGFR- TKI on survival. METHODS: From January 2000 to December 2006, patients with NSCLC aged 80 years or older with stage IIIB or IV disease at National Taiwan University Hospital were included. The medical records were reviewed and analyzed. A Cox proportional hazard model was used to calculate the hazard ratio and its 95% confidence interval for gender, performance status, histologic types, disease stages, smoking history, comorbidities, and initial treatment modalities. RESULTS: A total of 203 patients were included. Sixty-five patients (32.0%) were treated with EGFR -TKI as the first-line therapy, and all of them were admitted after 2003. After 2003, the proportion of supportive care significantly decreased (p < 0.001), whereas those of chemotherapy and radiotherapy showed no significant change. There was a trend of an increase in median survival from 2003 (2000: 37 days, 2001: 62 days, 2002: 69 days, 2003: 110 days, 2004: 85 days, 2005: 188 days , and 2006: 195 days). When compared with those who received supportive care only, patients who received EGFR-TKI therapy had a significantly better prognosis (hazard ratio: 0.56, 95% confidence interval: 0.40-0.80), whereas no significant survival benefit was found in patients who received chemotherapy or radiotherapy. CONCLUSION: For octogenarians with advanced NSCLC, EGFR-TKI may play an important role in the initial treatment modalities. Further large-scale elderly specific clinical trials for EGFR-TKI as first-line therapy are warranted