Longer overall survival (OS) was found to be associated with the use of chemotherapy among patients aged 80 years and older with metastatic non-small cell lung cancer (NSCLC), according to the results of a retrospective study published in Lung Cancer.

There are currently no specific treatment recommendations for patients aged 80 years and older with advanced NSCLC. “However, with an aging population, there is need for data that can assist the clinician in the management of 80 years and older patients with advanced NSCLC,” the authors wrote.

The retrospective study analyzed data from 33,352 patients at least 80 years of age from the National Cancer Database who were diagnosed with metastatic NSCLC between 2004 and 2014. The median age at diagnosis was 84; 49.7% were men; and 87.8% were White, 7.9% were African American, 3.0% were Asian, and 0.1% were American Indian. Adenocarcinoma was diagnosed in the majority of patients (68%), followed by squamous cell carcinoma (26.7%), large cell carcinoma (3.9%), and adenosquamous carcinoma (1.4%).

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Chemotherapy was administered to 29.6% of patients, including 11.8% who received a multiagent regimen and 17.8% who received a single-agent regimen.

Chemotherapy use resulted in prolonged survival. The median OS was 8 months with chemotherapy compared with 2 months without chemotherapy (hazard ratio [HR], 0.46; 95% CI, 0.45-0.47; P <.001). This translated to a 1-year OS of 34.4% and 10.5% with and without chemotherapy, respectively.

Multiagent chemotherapy was associated with longer OS than single-agent chemotherapy, with medians of 8.4 and 7.1 months, respectively (HR, 0.92; 95% CI, 0.88-0.96; P <.001). The 1-year OS was 35.5% with a multiagent regimen compared with 32.8% with a single-agent regimen.

In multivariate analysis, chemotherapy significantly improved survival among various age groups (P <.0001) and was regardless of gender, ethnicity, comorbidity index, treatment center, insurance status, tumor grade, histologic type, education level, and income status (P <.05).

The authors concluded that “this large retrospective analysis demonstrates the benefit of chemotherapy in very elderly patients with metastatic NSCLC.” They added that “very elderly patients should be evaluated for chemotherapy based on their functional status and comorbidities rather than chronological age.”


Ahmed Z, Kennedy K, Subramanian J. The role for chemotherapy in 80 years and older patients with metastatic non-small cell lung cancer: a National cancer database analysis. Lung Cancer. 2021;154:62-68. doi:10.1016/j.lungcan.2021.02.011