Chemotherapy for advanced non‐small cell lung cancer in the elderly population

Background Approximately 50% of patients with newly diagnosed non‐small cell lung cancer (NSCLC) are over 70 years of age at diagnosis. Despite this fact, these patients are underrepresented in randomized controlled trials (RCTs). As a consequence, the most appropriate regimens for these patients are controversial, and the role of single‐agent or combination therapy is unclear. In this setting, a critical systematic review of RCTs in this group of patients is warranted. Objectives To assess the effectiveness and safety of different cytotoxic chemotherapy regimens for previously untreated elderly patients with advanced (stage IIIB and IV) NSCLC. To also assess the impact of cytotoxic chemotherapy on quality of life. Search methods We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), MEDLINE (1966 to 31 October 2014), EMBASE (1974 to 31 October 2014), and Latin American Caribbean Health Sciences Literature (LILACS) (1982 to 31 October 2014). In addition, we handsearched the proceedings of major conferences, reference lists from relevant resources, and the ClinicalTrial.gov database. Selection criteria We included only RCTs that compared non‐platinum single‐agent therapy versus non‐platinum combination therapy, or non‐platinum therapy versus platinum combination therapy in patients over 70 years of age with advanced NSCLC. We allowed inclusion of RCTs specifically designed for the elderly population and those designed for elderly subgroup analyses. Data collection and analysis Two review authors independently assessed search results, and a third review author resolved disagreements. We analyzed the following endpoints: overall survival (OS), one‐year survival rate (1yOS), progression‐free survival (PFS), objective response rate (ORR), major adverse events, and quality of life (QoL). Main results We included 51 trials in the review: non‐platinum single‐agent therapy versus non‐platinum combination therapy (seven trials) and non‐platinum combination therapy versus platinum combination therapy (44 trials). Non‐platinum single‐agent versus non‐platinum combination therapy Low‐quality evidence suggests that these treatments have similar effects on overall survival (hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.72 to 1.17; participants = 1062; five RCTs), 1yOS (risk ratio (RR) 0.88, 95% CI 0.73 to 1.07; participants = 992; four RCTs), and PFS (HR 0.94, 95% CI 0.83 to 1.07; participants =