Immune checkpoint inhibitors convey survival benefit in elderly patients with stage IV non-small cell lung cancer

Because elderly patients with non-small cell lung cancer are likely to be excluded from clinical trials due to their lower functional capacity or comorbidities, survival benefit from immune checkpoint inhibitors (ICIs) remains unclear.  In patients with non-small cell lung cancer (NSCLC), ICIs have become one of the standard pharmacological therapies, but elderly patients may be denied these therapies in clinical trials. 

However, a new study presented today at the IASLC 2021 World Conference on Lung Cancer suggests age does not negatively impact on survival benefit from ICIs with stage IV NSCLC 

Dr. S. Takamori from the National Hospital Organization, Kyushu Cancer Center, Kyushu, Japan and co-researchers analyzed 86,173 patients with stage IV NSCLC—24,136 patients were age 75 and older and 62,037 patients were under age 75. 

Multivariable Cox modeling confirmed the survival benefit from ICIs for patients 75 years of age and older with stage IV NSCLC (HR: 0.61, 95% CI: 0.58–0.65, P < 0.0001). The corresponding hazard ratio in patients under age 75 was 0.68. Despite the known negative prognostic factor, the impact of age (75 years of age or older) on overall survival by univariate analysis was smaller in those with ICIs than in those without (HR 1.23 vs. 1.32). 

"Chronological age does not appear to impact on survival benefit of ICIs in stage IV NSCLC according to our large database analysis," reported Dr. Takamori. These findings should be validated in future prospective studies.