Older adults with late-stage NSCLC benefit from immunotherapy
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Older patients with late-stage non-small cell lung cancer appeared to benefit from immunotherapy, according to results presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
“Immune function is impaired [among] older patients, but whether these patients benefit from immune checkpoint inhibitors was unclear,” Shinkichi Takamori, MD, researcher in the department of thoracic oncology at National Hospital Organization of the Kyushu Cancer Center in Japan, told Healio. “In addition, older patients are often excluded from clinical trials; therefore, clinical benefit from immunotherapy in daily practice is unknown.”
Researchers used the National Cancer Database to identify 86,173 patients with stage IV NSCLC treated between 2014 and 2015.
The analysis included 24,136 patients aged 75 years or older (immunotherapy, n = 2,241; no immunotherapy n = 21,895) and 62,037 patients aged younger than 75 years (immunotherapy, n = 8,968; no immunotherapy, n = 53,069).
Researchers compared OS between patients who received immunotherapy and those who did not.
Univariate analysis showed a survival benefit with immunotherapy among patients aged 75 years or older (median OS, 11.9 months vs. 5.4 months; HR = 0.61; 95% CI, 0.58-0.64), as well as among those aged younger than 75 years (median OS, 14.5 months vs. 7.8 months; HR = 0.67; 95% CI, 0.65-0.68).
Multivariate analysis confirmed a survival benefit with immunotherapy in both age groups, showing poorer survival for patients who did not receive immune checkpoint inhibitors among those aged 75 years or older (HR = 1.63; 95% CI, 1.55-1.71) and among those aged younger than 75 years (HR = 1.5; 95% CI, 1.46-1.54).
“If elderly patients cannot receive cytotoxic chemotherapy due to lower functional capacity or poor performance status, oncologists can introduce them to immune checkpoint inhibitors as a treatment option,” Takamori said. “This study suggests that immune checkpoint inhibitor monotherapy is beneficial for elderly patients and that the combination of immune checkpoint inhibitor plus chemotherapy is also a standard first-line therapy.
“Some subgroup analyses of elderly patients from the clinical trial indicated that combination therapy of immunotherapy and chemotherapy is more beneficial to younger patients compared with elderly patients,” Takamori added. “Further study is needed to investigate whether immune checkpoint inhibitor monotherapy or combination therapy is appropriate for older [patients with lung cancer].”
Perspective
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Paul Wheatley-Price, MD, BSc, FRCP, MBChB
Depending on geography, the median age of lung cancer diagnosis varies, but it generally occurs between the ages of 65 and 72 years. Consequently, this is a major issue. There are hundreds of thousands of people in this age group, and we need to be able to guide them on treatment. Older patients need to have the confidence from their oncologist that there are effective treatments.
Geriatric oncology is becoming a broader branch of oncology and offers specific expertise. In general, we have known for years that cytotoxic chemotherapy can be safely administered to fit elderly patients, but in the older elderly patient population — those aged older than 80 years — there are much higher rates of adverse events. This is why identifying safe treatment is important.
The evidence we have thus far for immunotherapy in the elderly is encouraging. The advent of targeted therapies and immunotherapy allows for more elderly patients with lung cancer to receive immunotherapy and targeted therapy with confidence.
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Takamori S, et al. Abstract MA15.07. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer (virtual meeting); Sept. 8-14, 2021.
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