First-line Treatment in Elderly Patients with Advanced Non-small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide, and more than 40% of patients are 70 years or older at the time of diagnosis. Based on the results of previous large-scale randomized phase III trials of elderly patients with advanced NSCLC, several single-agent chemotherapy regimens have been recommended as first-line treatment. Recently, a large-scale clinical trial of targeted tyrosine kinase inhibitors for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) significantly prolonged survival and resulted in high response rates compared with standard chemotherapy as first-line treatment in patients with advanced NSCLC harboring EGFR mutations or the ALK fusion gene. Although various first-line treatment options are currently available for patients with advanced NSCLC, it is unclear whether any of these treatments are advantageous in the first-line treatment of elderly patients. This review focuses on chemotherapy regimens and targeted agents, especially for EGFR, ALK, and vascular endothelial growth factor, based on the latest clinical data.