Abstract
BACKGROUND: The survival benefit of first-line epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy in super-elderly patients with advanced non-small cell lung cancer (NSCLC) harboring active EGFR mutations remains unclear. METHODS: We conducted a retrospective evaluation of the difference in the overall survival (OS) among super-elderly (aged ≥ 85 years) NSCLC patients who had received best supportive care alone (BSC group, n = 36), cytotoxic chemotherapy (CT group, n = 11) or EGFR-TKI therapy (TKI group, n = 22). RESULTS: The median age of the patients was 88 years. Among the 35 super-elderly NSCLC patients with an performance status (PS) score of 0-2, 11of 18 EGFR wild-type patients received cytotoxic chemotherapy and 15 of 17 EGFR-mutant patients received EGFR-TKI therapy with gefitinib (n = 13) or osimertinib (n = 2). The OS tended to be longer in the TKI group than in the CT or BSC group (16.9 months vs. 7.2 months or 9.8 months, p = 0.059). Among the 34 super-elderly NSCLC patients with a PS score of 3-4, 7 with EGFR-mutant received gefitinib therapy and the remaining 27 received BSC alone. The OS tended to be longer in the TKI group than in the BSC group (4.6 months vs. 2.3 months, p = 0.060). Multivariate analysis identified a good PS before the start of first-line therapy and presence of active EGFR mutations reduced a risk of death. CONCLUSIONS: Gefitinib appears to be useful as a salvage therapy in super-elderly NSCLC patients with active EGFR mutation, regardless of their PS.