Update on treatment of small-cell lung cancer in the elderly

Small-cell lung cancer (SCLC) is the most aggressive form of lung cancer; it is characterized by a rapid tumor-doubling time and early metastasis. Although SCLC is extremely sensitive to chemotherapy, relapses are frequent and the 5-year survival is poor. Standard treatment for all stages of SCLC consists of chemotherapy with etoposide and a platinum-based agent. The addition of thoracic radiotherapy and prophylactic cranial irradiation significantly improves survival in limited-stage disease. However, their effect in elderly patients with extensive SCLC is unknown. Chronological age is an insufficiently sensitive parameter to determine which elderly patients would most benefit from treatment; a comprehensive geriatric assessment allows better tailoring of therapy. Elderly patients with good performance status and fewer comorbidities should be treated with standard SCLC treatment regimens. Clinical trials specifically designed for SCLC patients aged 70 years or older are urgently needed.