J Cancer 2016; 7(6):687-693. doi:10.7150/jca.14819 This issue


Tyrosine Kinase Inhibitors for the Elderly

Wolfgang Hohenforst-Schmidt1, Paul Zarogoulidis2✉, Michael Steinheimer1, Naim Benhassen1, Theodora Tsiouda2, Sofia Baka3, Lonny Yarmus4, Grigoris Stratakos2, John Organtzis2, Athanasia Pataka2, Kosmas Tsakiridis5, Ilias Karapantzos6, Chrysanthi Karapantzou6, Kaid Darwiche8, Athanasios Zissimopoulos9, Georgia Pitsiou2, Konstantinos Zarogoulidis2, Yan-Gao Man7, Harald Rittger1

1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany
2. Pulmonary Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
3. Oncology Department, “Interbalkan” European Medical Center, Thessaloniki, Greece
4. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Baltimore, U.S.A
5. Thoracic Surgery Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, Greece
6. Ear, Nose and Throat Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, Greece
7. Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA
8. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany
9. Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Thrace, Greece

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Hohenforst-Schmidt W, Zarogoulidis P, Steinheimer M, Benhassen N, Tsiouda T, Baka S, Yarmus L, Stratakos G, Organtzis J, Pataka A, Tsakiridis K, Karapantzos I, Karapantzou C, Darwiche K, Zissimopoulos A, Pitsiou G, Zarogoulidis K, Man YG, Rittger H. Tyrosine Kinase Inhibitors for the Elderly. J Cancer 2016; 7(6):687-693. doi:10.7150/jca.14819. Available from https://www.jcancer.org/v07p0687.htm

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Until few years ago non-specific cytotoxic agents were considered the tip of the arrow as first line treatment for lung cancer. However; age > 75 was considered a major drawback for this kind of therapy. Few exceptions were made by doctors based on the performance status of the patient. The side effects of these agents are still severe for several patients. In the recent years further investigation of the cancer genome has led to targeted therapies. There have been numerous publications regarding novel agents such as; erlotinib, gefitinib and afatinib. In specific populations these agents have demonstrated higher efficiency and this observation is explained by the overexpression of the EGFR pathway in these populations. We suggest that TKIs should administered in the elderly, and with the word elderly we propose the age of 75. The treating medical doctor has to evaluate the performance status of a patient and decide the best treatment in several cases indifferent of the age. TKIs in most studies presented safety and efficiency and of course dose modification should be made when necessary. Comorbidities should be considered in any case especially in this group of patients and the treating physician should act accordingly.

Keywords: erlotinib, gefitinib, afatinib, targeted therapies, elderly