treatment suggestion for elderly NSCLC Stave 4 - 1248966

Hi Colin,

I'm sorry to hear of your father's diagnosis. I hope that the radiation and Zometa has eased his pain. As you probably know, the three main types of treatment for lung cancer are surgery, radiation and chemo or other drugs. With stage IV NSCLC, I assume there is no role for surgery, except perhaps if he has bone mets or other tumors which are causing pain or other symptoms which need to be addressed for his comfort. That leaves chemo, which he has rejected, or other drugs such as the oral medication Tarceva. Even though he is EGFR negative, Tarceva can provide a more modest benefit than it usually provides to patients with an activating EGFR mutation. Tarceva is generally better tolerated than most types of chemo, although some patients do have quite a bit of difficulty with it.

I understand that he may not be interested in chemo because of his age, but the side of effects of chemo are better controlled than they used to be, so the current thinking is that it can be appropriate regardless of a patient's age. The more important factor is "performance status" which is a measure of the overall health of a patient aside from his cancer. A generally healthy 75 year old may tolerate chemo better than a less fit younger patient. Also, there are newer drugs which are better tolerated than some of the older ones. For lung cancer, a good example is Alimta (Pemetrexed), which many patients find easier to handle compared to other chemo drugs. And although the standard first-line treatment for lung cancer is a two- or three-drug combination including a platinum agent, often older or more frail patients are given just a single drug in an effort to make treatment more tolerable. So he may want to discuss such options with his oncologist.

My thoughts are with you and him for a good treatment plan.

JimC
Forum moderator

Jim has provided a terrific summary. I agree that Tarceva (erlotinib) may still provide some benefit, even if he doesn't have an EGFR mutation. And then the key concept is that being 75 absolutely doesn't preclude him from necessarily receiving chemotherapy. If he's very debilitated, chemo could be a choice that isn't likely to provide much benefit, but the median age for a newly diagnosed person with lung cancer in the US is right around 70-71 -- we routinely treat fit 75 year-olds with standard chemo, including combinations of drugs, and they can often do very well. The overwhelming evidence supports the idea that chronologic age is less important than functional age.

Here's a link to a podcast that provides a very good summary of the field of treating lung cancer in elderly patients:

http://cancergrace.org/lung/2011/10/03/lilenbaum-on-lc-in-elderly/

Good luck.

-Dr. West