Aging of the population has led to an increase in the prevalence of cancer among older adults. In Japan, single agent chemotherapy was recommended for advanced non-small cell lung cancer (NSCLC) for those, who were aged ≥75 years, while the Western guidelines did not recommend a specific regimen. In clinical practice, physicians are required to decide the treatment based on a lack of enough evidence. This study aimed to examine the prescribing patterns of first-line chemotherapy according to age in the real-world practice. Data from the survey database of Diagnostic Procedure Combination and hospital-based cancer registries of designated cancer centers nationwide were used. The first-line chemotherapy regimens among 9,737 patients who were diagnosed with advanced lung cancer between January and December 2013, were identified and compared based on age. We found that the proportion of patients receiving chemotherapy decreased with age; 80.0%, 70.4%, 50.6%, and 30.2% of patients aged 70-74, 75-79, 80-84, and ≥ 85 years, respectively, received chemotherapy. Among them, platinum doublets were prescribed for 62.7% of the patients who were aged ≥ 70 years, and 60.7% of the patients who were aged ≥ 75 years with no driver mutations in NSCLC; only 37.6% of them received single agents. Patients who were aged ≥ 80 years also preferred platinum doublets (35.6%). Carboplatin was commonly prescribed in all age groups; only 28.4% of those receiving platinum doublets selected cisplatin. In this study, platinum doublets were identified as the most commonly prescribed regimen in those who were aged ≥ 70 years. Despite recommendations of Japanese guidelines for NSCLC, 60.7% of those who were aged ≥75 years received platinum doublets. Additionally, patients who were aged ≥ 80 years also received systemic chemotherapy, including platinum doublets; age did not solely influence regimen selection.

中文翻译：

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日本老年患者肺癌的一线治疗：基于医院的癌症登记数据的真实世界分析。

人口老龄化导致老年人癌症患病率增加。在日本，对于 75 岁以上的晚期非小细胞肺癌 (NSCLC)，推荐单药化疗，而西方指南没有推荐具体方案。在临床实践中，医生需要根据缺乏足够证据来决定治疗方案。本研究旨在根据现实世界实践中的年龄检查一线化疗的处方模式。使用了诊断程序组合调查数据库和全国指定癌症中心的医院癌症登记处的数据。2013年1月至12月9737例晚期肺癌患者的一线化疗方案，根据年龄进行识别和比较。我们发现接受化疗的患者比例随着年龄的增长而下降；70-74 岁、75-79 岁、80-84 岁和 85 岁以上的患者分别有 80.0%、70.4%、50.6% 和 30.2% 接受了化疗。其中，62.7%的≥70岁患者和60.7%的≥75岁无驱动突变NSCLC患者接受了铂类双药治疗；只有 37.6% 的人接受了单一代理。年龄≥ 80 岁的患者也更喜欢铂双药（35.6%）。卡铂在所有年龄组中都很常见；只有 28.4% 接受铂双联治疗的患者选择了顺铂。在这项研究中，铂双药被确定为 70 岁以上人群最常用的处方方案。尽管日本针对 NSCLC 的指南提出了建议，60.7% 的 75 岁以上的人接受了铂双药治疗。此外，年龄≥ 80 岁的患者还接受了全身化疗，包括铂类双药；年龄不仅仅影响治疗方案的选择。