Lung cancer is the leading cause of cancer deaths in the Western countries. Recent advancements in the treatment of non-small cell lung cancer (NSCLC) have led to an improvement in outcomes, although 5-year survival rates remain about 15%. Moreover, the number of patients diagnosed and treated with lung cancer over the age of 65 years is growing. Despite this fact, elderly patients are infrequently included into clinical trials, which results in a limited amount of evidence-based options regarding therapy for the elderly. The limited data correlate directly with the lack of established treatment guidelines for elderly patients with NSCLC. In this article, we review both retrospective and prospective studies that help to define treatment of the elderly with early-stage, locally advanced, and metastatic NSCLC. Ultimately, increasing participation of the elderly within clinical trials is essential to firmly establish treatment regimens to increase survival while minimizing toxicity.