[Expert consensus on the treatment of advanced lung cancer in elderly patients (2025 edition)].

Abstract

Lung cancer exhibits the highest incidence and mortality among all malignancies in China, with incidence peaking after age 65. The growing elderly population has led to a significant increase in both the number and proportion of elderly lung cancer patients, necessitating standardized management for this group. The "Consensus of Chinese experts on medical treatment of advanced lung cancer in the elderly (2022 edition)" has provided essential clinical guidance in the past 2 years. However, evolving evidence-based medical findings and pharmaceutical advancements necessitate consensus updates. Against this backdrop, the Expert Committee on Geriatric Oncology Prevention and Treatment of the Chinese Society of Clinical Oncology (CSCO) has developed the "Expert consensus on the treatment of advanced lung cancer in elderly patients (2025 edition). Based on the 2022 edition, this revision encompasses five key domains: definition and characteristics of the elderly population, comprehensive geriatric assessment for elderly advanced lung cancer patients, treatment of advanced non-small cell lung cancer (NSCLC) and extensive-stage small cell lung cancer (ES-SCLC) in elderly patients, and management of treatment-related adverse events. The core features of this consensus update are highlighted as follows: 1. Refined age-stratified management. Patients are categorized into three strata: younger-old (65-74 years), middle-old (75-84 years), and oldest-old (≥85 years), with precision management emphasized for each stratum. 2. Elevated role of comprehensive geriatric assessment. Positioning comprehensive geriatric assessment as an essential core tool throughout diagnosis and treatment. 3. Stratified precision treatment strategies. Treatment selection for NSCLC/ES-SCLC patients should balance efficacy and quality of life based on age stratification and comprehensive geriatric assessment. 4. Enhanced focus on drug safety and interactions. Prioritizing drug-drug interactions (DDIs) alongside safer drug selection and adverse event monitoring. Nine key recommendations were finalized to guide clinical practice, promoting rational and standardized management of advanced lung cancer in elderly patients in China.