Resectable non-small cell lung cancer in the elderly: is there a role for adjuvant treatment?

Over the past 2 years, systemic chemotherapy has emerged as the standard adjuvant approach for resectable non-small cell lung cancer (NSCLC). In aggregate, a 5.3% improvement in 5-year survival has been observed with platinum-based combination chemotherapy in patients with NSCLC, with benefits being most pronounced in stage II and IIIa disease. Recent data suggest that the elderly (up to age 75 years) derive benefits from such therapy similar to those seen in younger patients. Unfortunately, although patients aged >or=70 years constitute 50% of those with newly diagnosed NSCLC, <10% of enrollees in clinical trials are in this age group. To help offset the spectre of increased risk in this age group, two potential strategies exist: (i) substitution of carboplatin for cisplatin; and (ii) increased use of neoadjuvant treatment to avoid perioperative co-morbidities and difficulties with compliance that can hamper appropriate administration of adjuvant treatment. To date, there have been no elderly-specific adjuvant trials in NSCLC. Over time, this omission is likely to be corrected.