Chemotherapy in elderly patients with non-small-cell lung cancer in Tunisian respiratory department

Old people affected by lung cancer are an increasingly common problem faced by oncologist. More than 50% of cases of advanced non-small-cell lung cancer (NSCLC) are diagnosed in patients aged over 65 years. Elderly patients have more co-morbidity and tend to tolerate toxic medical treatments less than young people. We followed 42 elderly men with NSCLC treated with chemotherapy to identify therapeutic difficulties and complications occurring during treatment. The average age of our patients was 68 years. We had 69% of adenocarcinoma and 31% of squamous cell carcinoma. The most impotant co-morbidities wee: hypertension 26%, chronic obstructive pulmonary disease 24%, dyslipidemia 14%, diabetes 12%, and coronary heart disease 7%. For 84% of patients, chemotherapy was palliative. Among the 16% of patients who were operated 86% received adjuvant chemotherapy and 28% received neoadjuvant chemotherapy. 71% of patients received one line of chemotherapy, 22% received 2 lines and 7% received 3 lines of chemotherapy. In 58% of cases, patients received single-agent chemotherapy (third-generation molecule) and in 42% of cases they received a combined therapy involving platinum. Side effects were observed in 78,5% of patients including neutropenia(35%), anemia(11%), thrombocytopenia(4%), bronchopulmonary infection (14%), pneumonia(4%), pulmonary abscess(2%) and renal insufficiency(4%). The median survival was 18 months. Elderly are at risk of both empirical under-treatment resulting in poor survival or excessive toxicity from standard therapy. Clinical data obtained in a younger population cannot be automatically extrapolated to the great majority of non-selected elderly patients with NSCLC.