Excellence in oncology care (EIOC) consensus guidelines on geriatric evaluation in non-small cell lung cancer (NSCLC) for the Middle East and Indian subcontinent

ABSTRACT The Excellence in Oncology Care (EIOC) 2023 Congress, held in Dubai, convened oncologists from the Middle East and the Indian subcontinent, both in person and online. The goal of this annual event was to develop the first region-specific consensus guidelines for geriatric evaluation in non-small cell lung cancer (NSCLC). A panel of 15 experts conducted a survey and held preparatory meetings to draft the guidelines, which were discussed at the congress. Lung cancer is the leading cause of cancer-related mortality worldwide, with NSCLC particularly prevalent in older patients, who present unique treatment challenges due to comorbidities and reduced organ function. The panel highlighted the urgent need for region-appropriate geriatric assessments (GAs), noting that existing tools developed for Western populations may not be suitable for local contexts. A threshold age of 60 years was proposed to define older patients in these regions, with an emphasis on physiologic rather than chronologic age. GA was deemed essential and recommended for incorporation into oncology training. The guidelines propose an abbreviated GA focusing on key domains: function, nutrition, comorbidities, cognition, and chemotherapy risk or life expectancy. Treatment recommendations include stereotactic body radiation therapy for early localized disease, carboplatin and pemetrexed for resected adenocarcinoma, concurrent chemoradiotherapy for unresectable disease, and maintenance durvalumab post-chemoradiation. For advanced, driver mutation-negative NSCLC, reduced-dose platinum-based chemotherapy combined with immunotherapy was preferred. The consensus underscores the need for more region-specific data and clinical trials to optimize outcomes for older adults with NSCLC.