Small cell lung cancer in the elderly patient

Small cell lung cancer (SCLC) is primarily a disease of older individuals. Many physicians and patients believe that lung cancer is less treatable in the elderly because of the presence of comorbid illnesses and an unwarranted concern for the patient's psychological well being. In reality, the prognostic relevance of age is not well defined. Older patients who are able to tolerate standard doses of chemotherapy appear to experience survival that is not substantially different from that achieved in younger patients. However, older patients who cannot tolerate the rigors of standard chemotherapy do less well for reasons that are still incompletely understood. Based on these observations, it has been suggested that specific therapeutic regimens that result in less toxicity but maintain adequate efficacy are needed for older SCLC patients, especially those who have a poor performance status. Single agents such as oral etoposide or carboplatin have been advocated in this setting because of their perceived efficacy and lower toxicity. However, recent randomized studies indicate that older patients should be treated with the same regimens that are used for their younger counter-parts. Single agents may be inadequate to achieve optimal results. A more prudent strategy may be one based on an estimate of the individual's likelihood of experiencing toxicity. Parameters for selecting patients who are at high risk for treatment-related complications are reviewed in this article.