Lung cancer is a common malignancy worldwide and is the leading cause of cancer-related deaths. Non-small cell lung cancer (NSCLC) accounts for about 80% of lung cancers, and the majority of patients have distant metastases by the time they obtain a diagnosis, losing the opportunity for surgery and radical radiation therapy, making palliative chemotherapy the main option for their treatment. Lung cancer is also a disease of the elderly, with more than 50% of patients with advanced lung cancer being over 65 years of age. Recent SEER data show that the median age of onset of lung cancer in the United States has reached 71 years at the time of diagnosis. Due to the physiological degeneration and the presence of concomitant diseases in the elderly, the resistance of elderly lung cancer patients to chemotherapy decreases and the adverse effects increase, and the treatment of NSCLC in the elderly has gained much attention. According to the 2003 ASCO lung cancer guidelines, the recommended treatment regimen for advanced NSCLC in the elderly is 3rd generation cytotoxic*** agent monotherapy; the results of some recent studies suggest that healthy elderly people can tolerate standard chemotherapy regimens. For this reason, the following options exist for the treatment of advanced NSCLC in the elderly; single-agent chemotherapy, non-platinum combination regimens, platinum-containing combination regimens and new targeted agents. Current status of chemotherapy for advanced NSCLC in the elderly Lung cancer is a geriatric disease and patients aged R70 years are usually defined as elderly patients in clinical practice. Age-related changes and comorbidities increase dramatically in this group; the large differences in physiological functional status among individuals suggest that they belong to a heterogeneous group. How to determine the tolerability of chemotherapy in elderly patients before treatment is an issue that clinical oncologists must face. Neither laboratory tests nor geriatric evaluation systems are sufficient to determine the geriatric status of patients. A detailed geriatric status assessment (CGA) has been shown to be better than the PS score and better reflects geriatric status. It includes evaluation of comorbid diseases, socioeconomic status, nutritional status, comorbid medications, functional dependence, emotional and cognitive status, expected survival and frailty.Waymenga et al. analyzed the predictive effect of CGA on adverse reactions in the elderly receiving paclitaxel/carboplatin or gemcitabine/carboplatin for advanced NSCLC and found that CGA did not predict overall grade 3-4 adverse reactions, toxicity-related serious adverse events and ≥2-degree neurotoxicity, but predicted adverse neuropsychological reactions and chemotherapy completion. However, this CGA item is too numerous for a heavy clinical workload. There are many misconceptions about the treatment of advanced NSCLC in the elderly in clinical practice; many patients and their families, and even medical personnel, believe that elderly patients have a short life expectancy, are poorly tolerant of chemotherapy, and are psychologically and physically fragile and poorly tolerant of chemotherapy and should not receive aggressive treatment. In patients with advanced NSCLC, the odds of patients receiving chemotherapy decrease significantly with increasing age. tang et al. analyzed data on elderly lung cancer patients with SEER and found that only a minority (25.7%) of the 21441 elderly patients received chemotherapy. In addition, older patients rarely have the opportunity to participate in clinical trials, with only between 15-27% of patients ≥70 years of age in phase III study subjects with advanced NSCLC in the United States, but this group accounts for about 50% of all lung cancers, so older patients need age-specific clinical trials to guide their treatment. A recent study by the NCCTG (northcentralcancertreatmentgroup) found that the median age in the geriatric-specific study was high, containing patients around 80 years of age. Patients in the geriatric-specific study had a lower incidence of serious events than older patients in the non-geriatric-specific study; ≥3 degree non-hematologic toxicity was 57% vs 81%, respectively. pThe efficacy of first-line treatment with erlotinib in advanced NSCLC at age 70 years was studied in 451 patients with a median age of 78 years, an objective remission rate of 14%, disease control rate of 54%, and PFS of 16. 4 weeks, with similar efficacy to pemetrexed or pemetrexed combined with gemcitabine. In conclusion, the treatment of advanced NSCLC in the elderly has transitioned from best supportive care to combination chemotherapy. Currently, third-generation cytotoxic agents alone remain the standard first-line treatment for advanced NSCLC, and a combination regimen of carboplatin-containing, low-dose cisplatin chemotherapy can be used for healthy elderly patients. Targeted therapy may be indicated for first-line treatment of advanced NSCLC in advanced age, poor PS or with significant comorbidities.